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STIGMA: When your lived reality in the mental health system clashes with their dreamworld 05/21/2013

Posted by ALT in Activism, Mental Health News, Patient Rights and Advocacy.
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2 comments

In last year’s blog “How to INCREASE stigma in mental health — fight stigma the conventional way,” we covered a few key points:

1. The disease model/explanation for so-called “mental illness” actually INCREASES STIGMA, while a psychosocial model/explanation slightly DECREASES it (good, replicable science has demonstrated this repeatedly)

2. When Glenn Close dresses her sister up like so: Glenn-Close

and films her standing in Grand Central Station proclaiming her “brain disease” for all to see, Glenn is actually demonstrating how BAD she is at fighting stigma. (couldn’t be worse, really)

Nevertheless, Glenn Close and her foundation (BringChange2Mind) are the media’s poster children for anti-stigma campaigns in mental health.

They’re in the news again today, releasing another PSA and (as always) keeping their stigma-fighting a careful blend of the specific and the vague.

The specific: Accept your diagnosis-for-life and TAKE YOUR DRUGS.

Jessie Close started showing signs of bipolar disorder in her early 20s… “I was given my first treatment in my late 40s and finally, the correct diagnosis — and medication — when I was 51. I’ll be 60 in July and I grieved for those lost years. There were careers I couldn’t handle because of it. I wish I was able to get help earlier.”

-          Jessie Close, sister of Glenn Close, wearer of “bipolar” t-shirt

The vague: What, exactly, is stigma?

What are foundations like BringChange2Mind really fighting for? There’s a brief reference to “social inclusion,” and of course a non-specific call for “laws to protect the mentally ill” (I hope that’s not a veiled reference to forced outpatient commitment!) – but that sure doesn’t tell us much. BringChange2Mind’s greatest impact so far has been the release of a PSA whose main message appears to be “psychiatric labels are LEGITIMATE references to actual BRAIN DISEASE, and to PROVE IT TO YOU we’re having them printed on t-shirts.”

(Also, buy our t-shirts for only $20!)

(Also, buy our t-shirts for only $20!)

Later in the article we hear from stigma expert Bernice Pescosolido: ”There are two parts to mental literacy, one is knowledge and the other is what to do about it.” She keeps it nice and vague – what knowledge? The knowledge that a biological model/explanation for “mental illness” is, not only untrue, but also MORE likely to produce stigmatizing beliefs and behaviors?

Technically a sociologist, Pescosolido has been doing “research” on this important topic for years. I decided to consult her corpus of academic publications. Somewhere, anywhere, can ANYONE tell us exactly what they mean when they say “stigma?”

Stigma= when lived reality clashes with their theoretical dreamworld

In a study of adult stigma towards children who have received mental health treatment, Pesconsolido and co-authors devised a four-question instrument to measure what they refer to as “stigmatizing beliefs.” After hearing a vignette that described the “symptoms” of a child with either depression or ADHD, participants were asked if they agreed or disagreed with the following statements:

(1) a child receiving mental health treatment would be “an outsider at school,”

(2) a child receiving mental health treatment would “suffer as an adult if others learned he/she had received mental  health treatment when young,”

(3) that the parents of the child in the vignette “would feel like a failure” if their child received mental health treatment, and

(4) that “regardless of laws protecting confidentiality, most people in the community still know which children have had mental health treatment.”

The more strongly you agree with the statements above, the more “stigmatizing” your beliefs about children’s mental health are – strongly agree with them all and you’ve got “high stigma.”

The authors assure us that “the reliability of this scale is .69”

Maybe they should have THAT printed on a t-shirt!

Oh yeah? PROVE IT: have it printed on a t-shirt!

So here’s what I’ve learned about stigma from Pesconsolido’s work:

Stigma is when you and your lived reality in the mental health system clash with the so-called anti-stigma activists’ dreamworld.

Because the truth is YES – to be falsely labeled as “brain diseased,” to be set apart from the rest of humanity for a unique program of dehumanization, the literal commercialization of your mental and emotional suffering, to have fundamental rights to bodily integrity, due process, freedom of association, etc. taken away – YES, this will make you an outsider.

To be so marked as a child WILL have serious consequences, even into adulthood, as many psychiatric survivors will testify.*

And NO, your confidentiality will NOT be maintained, not when the buying and selling of data about prescription medications is “commercial free speech,” not when there are EVER-SO-MANY dollars to be made from your compliance with a system that demands you accept your diagnosis-for-life and take your pills.

If recognizing these and other harsh realities means I have “stigmatizing beliefs” – so be it.

What kind of world are we fighting for?

Anti-stigma activists like Glenn Close & Co. seem to be fighting for a world extremely similar to our own, with only one key difference: nobody has to recognize the truths listed above, everyone has the literacy, the “awareness” to pretend, fully and convincingly, that the Emperor is indeed wearing the finest suit ever made.

If we all say it’s so, then it’s so… right?

No.

There’s also the option of fighting for a different world entirely. A world where mental and emotional suffering still exist (part of the human experience, you see), but where the response to them is grounded in a fundamental respect for the humanity and free will of the individual so suffering. (more on that HERE)

Dreamworlds — and their naked emperors — be damned.


* Here’s how Laura Delano’s lived experience of the mental health system clashed with the “anti-stigma” dreamworld:

When Psychiatry had first attempted to indoctrinate me as a young teenager, I was not yet vulnerable or hopeless enough.  When I eventually reached such a state, I surrendered myself immediately to a psychiatrist at America’s most prestigious private psychiatric institution, and became a full-blooded patient, passive and dependent and convinced of her brokenness, in a matter of weeks.  I believed him when he said I’d need “meds” for the rest of my life, and would have to learn how to “manage my symptoms” and “set realistic expectations” for myself.  I was sure that the “Bipolar” diagnosis was the explanation for all my problems, and that the prescribed “treatment” would be my solution.  I needed to be “Bipolar”, and I needed to want the antipsychotic, antidepressant, and sleeping pill prescriptions that were written for me at the end of that first session, because they gave me hope that something could, and would, change.  For, that’s what I wanted so desperately: a shift, some sort of momentum forward and out of the mire I was in.  With his MD and PhD from Harvard, my psychiatrist emanated this powerful promise for change.

Just what does it mean to say that I was indoctrinated into Psychiatry?

-It meant letting Psychiatry tell me who I was, and forgetting how to define myself.

-It meant surrendering my humanness and replacing it with the narrative of a “chemical imbalance”, of an abnormal “condition” that made me different from everyone around me.

-It meant that I never questioned anything I was told by a psychiatrist, psychologist, or social worker, because I believed that “mental health professionals” had science on their side, and expertise about me that I could never have.  After all, who would ever be so presumptuous as to question a doctor?!

-It meant sacrificing my agency, my sense of self, and my sense of responsibility and accountability to the DSM, to any proclamation made by a “mental health professional”, and to my “meds”.

-It meant that I stopped trusting my gut, following my instincts, or having faith in myself and my ability to feel big feelings or think intense thoughts, and that my psychiatrist was always on speed dial in case I needed an upped dosage or an extra therapy session when I sensed another “episode” coming on.

-It meant that I was fragile, “couldn’t handle” too much stress, was emotionally unpredictable (“labile” was a favorite word of mine), was “hypersensitive”, and was at the whim of my “disease”; indeed “being Bipolar” became my justifiable excuse for impulsive behaviors, fights with family or friends, and shirked responsibilities.

-It meant that most of my decisions began with, “My psychiatrist says that…”.

-It meant that I was Bipolar.

-It meant that I forgot how to stand up for myself and for my rightful place in the world.

-It meant that I no longer believed I should have full rights, as my “disease” made me less than human.

-It meant that I lowered my eyes in subservience before the shiny, gray-silver DSM-IV-TR, the Psychiatric Bible, my life’s definer.

-It meant that I worshiped at the altars of worn leather armchairs, praying to the Gods of DSM, Harvard Medical School, and Lexapro.

-It meant that I became convinced only Psychiatry could save my life and any scrap of sanity I may have had left; that if left to myself, I would surely perish.

(from Laura Delano’s brilliant essay: “Reflections on a Psychiatric Indoctrination, or, How I Began to Free Myself from the Cult of Psychiatry“)

“Depression is really a chemical imbalance of the brain” – just one more branch on the eugenics tree 12/03/2012

Posted by ALT in Activism, Depression, Mental Health News.
Tags: , , , , , , ,
22 comments

Two Northwestern professors (Cristina Traina and Laurie Zoloth) wrote an article in response to a college student’s suicide, entitled “Culture stigmatizing mental illness must change.” It reads, in part:

Learning to accept your limits is learning what it means to be human. Realize that although difficult events can trigger depression and suicide, depression is really a chemical imbalance in the brain. You can no more adjust this balance than a diabetic can will their body to make more insulin or a person with low thyroid production can think themselves out of fatigue. At the physical level, the brain, like any organ, can become unable to function properly — in this case, to imagine that there are other futures beyond the intensity, or the injustice, or the pain of this moment.

What can you do for yourself and your friends? First, get rid of the stigma around depression, suicidal thoughts and treatment for mental illness. We need to learn to talk about mental illness like we talk about cancer, a serious emotional and physical crisis that can be treated, whose sufferers need support and decency and understanding as they face a life-threatening illness. Depression and anxiety are more common than asthma. You wouldn’t stigmatize a friend for using her inhaler; she shouldn’t feel shame if she uses Prozac to function, too.

- from Culture stigmatizing mental illness must change

I had to respond.

***

FROM: ALT
TO: Cristina Traina and Laurie Zoloth
CC: Editors, Northwestern Daily and Huffington Post College
SUBJECT: Response to your article: “Culture stigmatizing mental illness must change”

Dear Professors,

In your recent Huffington Post article (Culture stigmatizing mental illness must change), you wrote that “depression is really a chemical imbalance in the brain.” I understand this was not an academic publication – but could you provide a citation to back this up?

Try.

You’ll find it impossible to do so; because this mantra, this advertising slogan is about as scientific as the statement that “the best part of waking up is Folgers in your cup!” The best? Really?

Meanwhile, let me provide with you with a few citations of my own:

[Antidepressant] advertising campaigns have revolved around the claim that SSRIs correct a chemical imbalance caused by a lack of serotonin… Contemporary neuroscience research has failed to confirm any serotonergic lesion in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency… In fact, there is no scientifically established ideal “chemical balance” of serotonin, let alone an identifiable pathological imbalance.

- from Lacasse, J.R. & J. Leo (2005) Serotonin and Depression: A disconnect between the Advertisements and the Scientific Literature.

A serotonin deficiency for depression has not been found.

- Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, in Prozac Backlash (2000)

 Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims.

- Professor Emeritus of Neuroscience Elliot Valenstein, in Blaming the Brain (1998), which reviews the evidence for the serotonin hypothesis.

But I am not writing merely to correct a factual error in your post – there’s more.

When an advertising gimmick is touted as scientific fact and even entered into the canon of “common sense,” there are bound to be some serious consequences. Consider:

  1. Rather than helping us “learn what it means to be human,” as you say, the chemical imbalance theory actually tells us that some people are born with brains that don’t function properly. That are, in some fundamental way, pathological. Put another way, there are the mentally fit and the mentally unfit. Sound familiar? To any student of late 19th/early 20th century eugenic thought in the West, it would sound mighty familiar.eugenics-story
  2. The theory also supports another common biopsychiatric fallacy: that an individual with a mental health diagnosis will need to take psychiatric medications for the rest of his/her life, to “correct the imbalance,” as the story goes. Long-term use of most classes of psychotropic drugs (including antidepressants, antipsychotics, and mood stabilizers) not only comes with serious, LIFE-THREATENING adverse effects, but can actually serve to make what could be rare occurrences of severe mental emotional/distress chronic and repeating. In some cases, this remains true even after withdrawal from the offending chemical agent. (see Robert Whitaker’s Anatomy of an Epidemic for chapters of information devoted to this astonishing truth).
  3. Finally, the chemical imbalance theory takes nearly all agency away from the individuals who are suffering from mental/emotional distress – they become the victims of whatever their faulty, off-balance brains inflict on them. You write that a person “can no more adjust this [depression-inducing chemical im]balance than a diabetic can will their body to make more insulin or a person with low thyroid production can think themselves out of fatigue.” How horrible if this were so! The kinder truth is there are many strategies a distressed individual can employ that are not purely chemical or pharmaceutical, but rather make use of the mind, will, spirit, and being. That empower, enliven, and entail a joyful discovery of strength, stamina, and RESILIENCY within the human being, who is indeed FIT TO LIVE in whatever way he/she chooses!

You express a desire to reduce stigma in mental health – I think this is admirable. Unfortunately, several scientific studies have demonstrated without a doubt that the “chemical imabalance” theory of mental health issues has the opposite effect: it increases stigma.

For example, in 1997 Sheila Mehta of Auburn University conducted a simple experiment on stigma in mental health, comparing the “chemical imbalance” model to the psychosocial model (which acknowledges a broad variety of factors – including family, past trauma, diet, environment, etc. – as potential contributors to emotional distress). 

55 male college students were enrolled, and each one was told that he and a partner would have to do a simple learning task. The partner was actually a confederate, who would disclose a mental illness to the subject and then explain either that he had this illness because of “the kind of things that happened to me when I was a kid” [psychosocial] or that he had “a disease just like any other, which affected my biochemistry” [biochemical].

It turned out the group presented with the biochemical explanation were far more likely to treat their partners harshly than the group presented with the psychosocial one.  Says Mehta, “The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms.  We say we are being kind, but our actions suggest otherwise… Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.” [See: Mehta, S. (1997).  Is being “sick” really better?  Effects of disease view of mental disorder on stigma]

Rather than learning “to talk about mental illness like we talk about cancer” by doing as you suggest and falsely promoting it as a merely physical problem of chemicals out of balance,  I say we need to talk about mental and emotional distress in psychosocial context. AND in context of community, society. What is it about our culture, our rather toxic life on this planet, that makes people sick? And even more importantly, what can we as a society learn from these individual experiences of distress?

eugenics_tree_logo21I take it you are sincere in your desire to help young people support each other in dealing with the distress that seems to hit so hard at the dawn of true adulthood. Surely, as scholars and seekers of knowledge, you recognize that truth, however complicated and elusive it may be, is vastly preferable to an oversimplified falsehood? Especially when that truth embraces the human potential to survive and thrive, while the falsehood embraces a technocratic romance with chemicals and a eugenical division of what were once human beings into groups of “fit” and “unfit” participants in this consumerist, sick culture.

If you want to help, tell the truth. If you’re not sure what the truth is, take the time to find out. Go slow, think critically, ask questions. Look for the roots of ideas, the beginnings of things, and then follow them from earth to sky – and all the branchings inbetween.

This will not be easy – psychiatry is a strange plant, indeed. But our community needs you to be more than just professors; we need you to be professors of TRUTH.

Can you? Will you?

Yours truly,

Alice Tremont
Mental health writer and activist
http://altmentalities.wordpress.com

***

UPDATE:

I have received a response from one of the professors. She actually seems pretty open to considering what I said and has asked for time to research the information I shared. I’m not going to post her response yet because I’d like to win her trust — I think she really wants to dialogue! — but I hope to document our conversation here once it’s developed a bit more. I’m looking forward to a valuable exchange with her.

How to INCREASE stigma in mental health — fight stigma the conventional way 09/10/2012

Posted by ALT in Bipolar, Depression, Mental Health Awareness, Mental Health Research.
Tags: , , , ,
11 comments

Mental illness is a biological disease like any other… Schizophrenia is just like diabetes!

It is the mantra of mainstream psychiatry.

And the typical justification presented for the continued repetition of this mantra (despite its being patently false, both from a subjective and objective point of view) is the theory that characterizing “mental illness” as a brain disease reduces stigma.  The general public won’t blame afflicted individuals once they realize that it’s just a matter of faulty chemicals, a somewhat defective brain.  They won’t fear the disease if they believe that lifelong, routine injections of a necessary but missing chemical (like an insulin shot!) will solve the problem.

Here’s an example of the mantra (and its accompanying justification) in action, from Glen Close’s highly publicized “Bring Change 2 Mind” campaign to decrease the stigma of mental illnesses:

LEARN THE FACTS

One of the best ways you can help someone with mental illness is by understanding what it is – and what it isn’t.  After all, myths about mental illnesses contribute to stigma…

The fact is, a mental illness is a disorder of the brain – your body’s most important organ – and 1 in 6 adults lives with a brain-related illness including depression, bipolar disorder, PTSD and schizophrenia… And just as with most diseases, mental illnesses are no one’s fault.

- from the “Bring Change 2 Mind” website*

This organization has a celebrity spokesperson and billboards (!)

… so they must know what they’re talking about, right?

LEARN THE ACTUAL FACTS

FACT 1:  So-called mental illnesses (let’s call them “subjective experiences of mental and emotional distress”) CANNOT be reduced down to mere imbalances in brain chemicals. 

First of all, there’s NO KNOWN WAY to measure the balance of chemicals in someone’s brain.  No method of establishing what a so-called “normal” balance of chemicals would be.  Even if there WERE a method for measuring this, there’d be no reason to assume that this would somehow be universal across people of disparate genetic, biological, cultural, emotional, environmental backgrounds – which mainstream psychiatry seems bent on doing.

Second, numerous (far too numerous to list here!) studies show that a variety of factors besides “biological” ones – ie, the introduction of new chemicals, in the form of pharmaceuticals, into someone’s body – have a profound effect on the resolution of mental and emotional distress.  To list one simple example, outcomes for first-episode psychosis (typically leading to a diagnosis of “schizophrenia”) are very different in industrialized societies and non-industrialized societies, because the standard of care is different: industrialized societies emphasize medication as first-line and perhaps the only treatment, while non-industrialized societies emphasize social support and integration into the community combined with little or (more often) no medication.  Here’s another great article that goes through a few more examples of how culturally specific mental and emotional distress (and our reactions to it!) can be.

FACT 2:  The disease model explanation for so-called “mental illness” actually INCREASES STIGMA, while a psychosocial model explanation slightly DECREASES it.

That’s right, folks: the disease model, describing mental and emotional distress as mere chemical imbalances of the brain, is not only false – spreading that falsehood markedly increases stigma!  So when mainstream psychiatry claims it may need to tell a “white lie” about all this for the patients’ own good (reduce stigma, get folks to take their meds, etc.) they’re wrong again.

In 1997, Sheila Mehta of Auburn University conducted a simple experiment to test the stigma produced by a disease-based explanation of so-called “mental illness” and a psychosocial one.  55 male college students were enrolled in an experiment.  Each one was told that he and a partner would have to do a simple learning task – but the partner was actually a confederate in the study.  The confederate would disclose a mental illness to the subject, and then explain either that he had this illness because of “the kind of things that happened to me when I was a kid” [psychosocial] or that he had “a disease just like any other, which affected my biochemistry” [biochemical].

It turned out the group presented with the biochemical explanation were far more likely to treat their partners harshly than the group presented with the psychosocial one.  Says Mehta, “The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms.  We say we are being kind, but our actions suggest otherwise… Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”

[Mehta, S. (1997).  Is being “sick” really better?  Effects of disease view of mental disorder on stigmaJournal of Social and Clinical Psychology, 16(4), 405-419.]

Later studies (like this one involving over 450 people in New Zealand) have replicated Mehta’s results and agreed with her conclusion.  What’s that mean? 

It’s actually SCIENTIFICALLY SOUND

unlike the disease-based “biochemical imbalance of the brain” theory, which has still not been proven true, in part or in whole, despite over 40 years of extremely well-funded studies directed towards that very specific purpose.

We do not know the causes [of any mental illness]. We don’t have the methods of ‘curing’ these illnesses yet.  

-Dr. Rex Cowdry, psychiatrist and director of National Institute of Mental Health (NIMH), 1995

[While] there has been no shortage of alleged biochemical explanations for psychiatric conditions…not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven false.

 -Dr. Joseph Glenmullen, Harvard Medical School psychiatrist

    

  

  


[today's dose of sarcasm will be footnoted]

*A few other goodies from the “Bring Change 2 Mind” website

An image of Glen Close and her BIPOLAR sister. 

See the difference – one person is NORMAL, and the other is BRAIN-DISEASED.  It says it on their shirts!  (Not stigmatizing at all…)   And for the mere price of $20 a pop you, too, can wear an anti-stigma shirt with your diagnosis printed clearly across the front, labeling you. 

Anyone? Anyone at all want to fight stigma by labeling and stigmatizing yourself?

I think this is a far better way to fight stigma — rip those labels up!

One psychiatrist’s change of heart – a template for broader psychiatric reform? 05/23/2012

Posted by ALT in DSM-5, Mental Health News.
Tags: , , , , , ,
4 comments

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.

Is a mental illness like diabetes? 02/21/2012

Posted by ALT in Mental Health Awareness, Survivor Voices.
Tags: , , , , ,
8 comments

Having a mental illness is like having diabetes.

It is the most resounding mantra of mainstream mental health.  I probably heard it hundreds of times in the first few months of my employment in the mental health system; investigating the true meaning of this phrase was literally my entryway into critcal thinking about mental health care in our society.

What does it really mean when someone (almost inevitably a professional) says this? 

They say it means a reduction of stigma — for if mental illness is like diabetes, it’s nobody’s fault, right?  Just a biological fact of life for some folks.

Paradoxically, they say it means there’s something fundamentally flawed and wrong about your brain, your neurochemistry.  They say this chemical imbalance can only be corrected with lifelong medication compliance.  Adherence to the doctor’s orders gauruntees you a good life (or the best possible under such conditions); non-compliance is a recipe for disaster.

Is this comparison of mental illness to diabetes in any way useful, or is it misleading and inherently stigmatizing?

Let’s let someone who has truly lived this metaphor, experiencing it first hand as a pschiatric survivor, answer the question for us.

The following are excerpts from a brilliant essay published anonymously in 2006 in the Schizophrenia Bulletin.  The author, who reports a diagnosis of “schizoaffective disorder,” explains eloquently and succinctly why, for him/her at least… 

Having a mental illness is NOT like having diabetes. 

The Hospital Experience:

A diabetes patient in hospital can expect a clean, hygienic ward peopled by staff who treat the patient with respect, as an equal, who explain the illness and the treatment regime, and who co-opt the patient as an important agent in his or her own recovery. A psychiatric patient, however, might well find a ward that is rundown and peopled by staff who do not seem to have the same expectations of respect for patients and of a generally good professional working relationship between staff and patients. A psychiatric patient might instead, as I did in one of my hospitalizations, find staff who avoided talking to the patients as far as possible and whose only interaction with patients was to give commands.

The author is not the only one to have observed this trend of the division between staff and “patients” in mental hospitals.  See this fascinating study for more.

Stigma:

Schizoaffective disorder rips straight into the heart of the family, causing shame, anger, guilt, and self-blame from parents and siblings, as well as casting blame on the patient. Parents ask, where did I go wrong, and patients ask, if I had had a different upbringing could I have avoided this disease? With diabetes, however, there is no sense of blame, guilt, or shame; rather, people hear the diagnosis, learn (perhaps over time) about the condition, and come to accept the limitations of the condition.

In (naturally occurring) diabetes, there is no place for blame.  It doesn’t appear to be a particularly useful or therapeutic concept.  I find myself thinking that the same is probably true of mental illness.  There’s a firestorm of protest going on over at Mad In America right now about Michael Cornwall’s supposed blaming of families for the mental illness of their children (the article which stirred up so much criticism happens to be one of his best — I highly recommend you check it out). 

Ultimately, I think we are best served by abandoning the conecpt of blame altogether.  One commenter there put it so well:

I think that the problem of laying the blame on families is better resolved by getting the blame out of the equation rather than getting families out of it. It’s not about who did what to whom; it’s about understanding that we become who we are within the relationships that are important to us, so understanding them is part of understanding who we are. I think it’s when we take those relationships out of the equation that people start to look broken or crazy or mean.

So the first step is to get rid of blame. The next is to understand the significance of the relationships.

Kermit Cole, commenter at Mad In America; emphasis added

And now back to our anonymous author…

Treatment:

Diabetes treatment does not require the same sacrifice of personal privacy that nonmedical treatment for schizoaffective disorder does…  Diabetes medicine does not change who a person is; it does not turn one into a zombie, negating the highs as it flattens out the lows; it does not change the way one operates or, in fact, change what it is to be that person. Medicine for schizoaffective disorder does.

 Finally, the author suggests an alternative metaphor:

If I could choose a replacement analogy, I would say schizoaffective disorder is like a whirlwind: it comes out of nowhere, strips you naked and sucks you dry, and swiftly vanishes, leaving you empty and shaken but alive, wondering if it really did happen and whether, and how soon, it will come back again.

Isolation and stigma in the art of Craig Hawkins 03/12/2011

Posted by ALT in Mental Health Awareness.
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Stumbled across this series of paintings by the young artist Craig Hawkins the other day.  Beyond the stated themes of the series, I think they speak very well to madness, stigma, and dehumanization.

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His description of his work: 

A series that seeks to question the way we hide. Dealing with isolation, and compartmentalizing. What feels safe and comfortable may not always be beneficial. We were created with the need for community, and communication beyond ourselves. Struggling to reach out and make the personal something accessible and local requires acts of love and patience. Asking questions is a great way to encounter someone else’s inner dialogue with the hope of understanding. The hope of relationship. It’s seeking the heart not the box.

(from the website of Craig Hawkins)

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