To be a Psychiatric Critic

What does it mean to be a critic of the psychiatric industry? There are a couple ways we could go with this, considering there are many people who claim to be critics, who claim they recognize “there are some flaws in the system”, or that “things could be improved”.

That doesn’t tell me much about their understanding of the industry. What that tells me is that they have general knowledge that nothing in this world is perfect and that everything, theoretically, could use improvement. Why is this not a criticism? Well, because it’s well understood, it’s not unique, and it doesn’t require any real knowledge of the system to say.

I could walk into a Wells Fargo Bank, turn to the person in line behind me and say “wow, this building could really use some improvements, look at that crack in the ceiling.” You wouldn’t call that a true critique of their building, of their establishment, of their maintenance crew, would you? I made an observation a million other people have before me, and a million other people will after me, and I still know nothing about why the crack is there, what’s halting repairs, who the crew is who should be patching it, how much of a budget there is for repairs–all the things I’d need to know to really understand this situation.

There are enough cracks in the psychiatric system to ruin fifty thousand Wells Fargo Bank buildings.

 

To be a critic of something like psychiatry you need a little more gut than what it takes to have the same opinion as everyone else. You have to be willing to put in the effort it takes to read the research and understand that what isn’t being said to the public is much more powerful than what is being said to the public.

To be a critic of something like psychiatry you need the ability to put aside your personal beliefs sometimes and view the facts:

  1. Big Pharma is, well, a BIG corporation.
  2. There is no definite research that proves any mental “illness”, including schizophrenia and bipolar, are diseases. THAT is a theory.
  3. There is no definite research that proves any mental “illness”, including schizophrenia and bipolar, are a result of chemical imbalances. THAT is a theory.
  4. Know what a theory is. Know that it can never be proven, only disproven. 
  5. Know that the APA (they write the DSM), Big Pharma, and insurance companies speak with each other.
  6. Understand that none of this means you should immediately stop all of your medication. I’ve done that. It. Sucks.
  7. Understand that the only scientifically verified chemical imbalance occurs when medications are taken.
  8. Understand homeostasis in the brain and what happens when it’s disrupted.
  9. Know the history of psychiatry; know it’s a business. 
  10. Understand the politics involved in the business.

The two in bold are fairly important. They’re important because it is impossible to truly understand a system without knowing where it came from, how it started, and what philosophy drove it into existence.

Knowing about theories seems so incredibly basic, but a lot of people misunderstand it when they read about chemical imbalance. So let’s debunk this a little to further drive the point of an actual criticism.

Chemical Imbalance Theory: Things called mental disorders/diseases/illnesses, whatever, possibly caused by an imbalance of natural chemicals in the synapses during neurotransmission. The evidence consists of studies done on the brains of people who have taken medication at one point, or who are currently on it. Studies done of people during hallucinations or mania or depression. Studies done on small groups of people, once or twice, with results being generalized and any possibilities of traumas in the past being disregarded.

Let’s think scientifically here, and disregard any opinions we may or may not have about mental “illness”. Let’s also keep in mind that the neural connections within the brain are unique for each individual, like a finger print, and they change with our experiences in life.

If we are doing studies on people who are, or have been on medication, it can’t be ruled out that the experiences aren’t being worsened or created by said past/present medication.

If we are doing studies on people who have been having these experiences for years, and have never done a study on them in infancy (I’m talking 0-3 years of age), then we have no standard to hold it against: it can’t be an imbalance if there is no “balance” as a control. And for those saying they have scanned the brains of people who don’t have these experiences, how can that be considered a true control when every brain is uniquely different in their neural connections? Scientifically, that makes zero sense. To the general public, it makes a bunch of sense. We really need to start putting more funding into STEM programs if the general public is accepting sub-par experiments like this.

Because there has been such little research on how environment, trauma, and social factors play into the development and constantly changing plasticity of the brain, ignoring those key areas of life is essentially saying the brain only relies on its physical structure to know when to release chemicals. And that doesn’t make sense, considering there are external sources, like a blooming flower, that cause in some of us a rush of emotion like happiness,  a rush of dopamine. Had we not seen the flower, that dopamine may not have been released.

In a very thought-out article on Scientific American you can read here sums this up perfectly and has one of my favorite quotes by neuroscientist Joseph Coyle at Harvard: “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that.”

This articles points out, in regard to depression, that although pharma makes claims that there are certain decreased or increased levels of neurotransmitters which cause depression, there are several different antidepressants that act on several different neurostransmitters, increasing or decreasing, that work for different people in different ways. Essentially, that takes the power out of what the pharma companies claim.

DR. Mark Graff, Chair of Public Affairs of the APA said simply that the theory of chemical imbalance was “probably drug industry derived”.

Psychiatrist David Kaiser touches on the exact problem I stated above when he says “Patients [have] been diagnosed with ‘chemical imbalances’ despite the fact that no test exists to support such a claim, and . . . there is no real conception of what a correct chemical balance would look like”.

Just as there are theories in physics, there are theories in psychiatry. They can’t be proven, but they can be disproven, debunked, and through true criticism of this industry that is achievable on a widespread scale.

So the next time you go to rest in that comfortable middle ground of “the system could use some improvements, but everything could”, think about what you mean and how you formed that opinion. We don’t need anymore complacency in this world, particularly not in psychiatry. We need strength and understanding and facts.

To read up further on where I got the quotes above, see this pdf.

To read up on my thoughts on the system published on Mad In America, click here.

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Soteria, Peer Respites, and The Future.

In honor of 7/10: a special piece on a particular psychiatrist who helped catalyst alternative thinking within the psychiatric system. July 10th was the 13th anniversary of his death. He was also one of many sporadic voices focusing a harsh light on the cracks in the dam of the system, particular the APA of which he was a board member for 35 years. In his resignation letter on December 4, 1998, he stated clearly the truth:

“Unfortunately, the APA reflects, and reinforces, in word and deed, our drug dependent society. . . at this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support . . .”

He had a few choice words about the organization NAMI.

“In addition, the APA has entered into an unholy alliance with NAMI (I don’t remember the members being asked if they supported such an organization) such that the two organizations have adopted similar public belief systems about the nature of madness. . . NAMI, with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda to move forward. . .”

And of course, his words on the DSM:

“And finally, why does the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document . . .”

We’re talking, of course, about Loren R. Mosher, M.D. If you’d like to read his letter of resignation, you can click here. It’s fairly short, but highly powerful. He speaks on the fact that there is no damning or solid evidence to support that any “mental illness”, particularly schizophrenia, is a “brain disease”–which still holds true to this day. The studies conducted on the flow of neurotransmitters during “active” phases have two invalidating, but obvious, issues:

  1. In early experiments, people were on neuroleptics. That obviously effects neurotransmitters. Invalid.
  2. We have nothing to compare this to: the so-called “decreased white matter” or “increased dopamine” could be a result of so many things, including years of antipsychotics, and without tracing this person and their exact brain chemistry since fetal development and birth, without having a clear image of their brain chemistry before the onset of their experiences, there’s no possible way you can conclude, and be valid in your conclusion, that those two observations are the result of a “disease”. INVALID. INVALID. INVALID. 

Mosher felt the acceptance of schizophrenia as a “disease” was essentially just a function of “fashion, politics, and money”.

Don’t feel invalidated by that, because he’s not invalidating individual experiences here, he’s invalidating the economic leverage organizations like the APA or NAMI or Big Pharma receive from promoting this idea of “brain disease”, by publishing weak data the public would never notice if they didn’t take five psychology research courses in college. How many of us with mental health issues have taken five psychology research course in college, including behavioral statistics? How many of us, when we read a research paper, really know what we’re reading? 

Many of us never read the actual paper, we only read what’s been reiterated in other articles. That’s like playing that game “telephone” when you were a kid: whispering different phrases in each other’s ear and when the last person says what they heard, it’s never what the first person said. That’s exactly what this is like.

Mosher didn’t just run around spewing “psychiatry is a lie! You’re being dooped!” with a sign on his chest saying “THE END IS NEAR” and a tin foil hat. He was born in Monterey  California, obtained his first degree from Stanford and his medical degree from Harvard where he received his psychiatric training. To me, that means nothing. What he went and did with it, I respect.

He visited Kingsley Hall in England (more on THAT in a different article), learned what he could, skeptical of the level of support, returned to the U.S and became the first chief of the NIMH Centre for Schizophrenia studies. Within those years, inspired by many past theories, philosophies, and attempts, Soteria Project started.

This wasn’t your average experiment. This wasn’t 30 days with a few questions, a sugar pill, and a checkmark by your name. This was a lengthy study, and the community stayed open from 1971-1983, with a two year follow up, and not-so shocking results–depending on who is reading the research.

Here’s a quick overview of the project.

Requirements:

In order to be apart of this experiment, one needed to meet certain requirements:

  1. A diagnosis, by 3 individual clinicians, of schizophrenia (based on the DSM 2).
  2. Deemed in need of hospitalization.
  3. At least 4 of 7 Bleulerian diagnostic symptoms (explained below) by 2 independent clinicians.
  4. Not more than ONE hospitalization for 30 days or less.
  5. Ages 18-30
  6. Marital Status: Single

Bleulerian symptoms: “autism”, in this way meaning a withdrawal from reality into fantasy, and affect (flattened, inappropriate), associations (loose ones), and ambivalence (mixed/contradictory feelings). Hallucinations–mostly voices, thought broadcasting, somatic mix-ups (believing someone else is imposing something on your body), delusions–all those kinds of fun things.

The purpose of the age and the hospitalization requirement wasn’t to exclude old people, it was so the project could hold some validity: the individuals taking part needed to have never been drowned in the system, or muddied up with medication. For comparison, Soteria was running up against traditional hospital treatments: confinement, involuntary medication, involuntary isolation, and stigma.

The Experiment:

Mosher describes Soteria as follows:

 “. . . a 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment. The core practice of interpersonal phenomenology focuses on the development of a non-intrusive, noncontrolling, but actively empathetic relationship with the psychotic person without having to do anything explicitly theraputic or controlling.”

The key word here, being empathetic. Not sympathetic. Not pity.

Well, there are several key words. Nonintrusive. Noncontrolling. Homelike. Supportive. Not things you usually associate with a mental health facility.

In his words, he describes the role of these “nonprofessionals” as someone who is “standing by attentively”, or “being with [the person]”, or “stepping into the other person’s shoes”. If anything, the point of the staff was to “develop a shared experience of the meaningfulness the client’s individual social context, current and historical”.

They took a bunch of psychology graduates in their mid twenties, and stuck them in an environment with people aged 18-30 who were actively “psychotic”. That’s the bottom line. There was no medication intervention. A psychiatrist stood by as peripheral, but he never was involved in treatment or decisions. He was kind of like a mannequin with eyes that blinked–that’s about as useful as he needed to be.

For many individuals, it took 4-6 weeks for their lucidity to break through and they were able to have conversations about where they wished to go next, what they wished to do, and built a plan around that with staff.

“Subjects” stayed for 5 months. The control subjects who were in for hospital admission stayed 1 month. Regardless of that difference, the cost for “treatment” was the same for both: around 4,000 dollars each.

Results:

The first six weeks there was marked improvement in communication, focus, and wellbeing, regardless of the lack of neuroleptics. After the two year follow up, only 3% of those from Soteria were maintained on medication. Compared to the control levels from the hospital, those at Soteria during the years 1971-1976 two years postadmission had higher level jobs, lived independently or with peers, and had fewer re-admissions.

There were two other Soteria-like programs built: Emanon and Crossing Roads. Crossing roads included clinical staff, medication, and a shorter more “motivation” focused stay: helping people prepare for life in society. You can read the compare and contrast in that straight from the source, linked below.

In order for programs like this to work as well as they did in his study, Mosher developed some guidelines:

  1. The setting needs to interact with the community and be indistinguishable from the community (I.e, a house on a block in a neighborhood).
  2. A small space, fitting about 6-10 people and admission must be informal and thoughtful of the person’s mental state.
  3. The staff isn’t there to bombard or control. They must be willing to understand “immediate circumstances and relevant background that precipitated the crisis”. This is what fosters the relationship and connection that allows staff to step into the other person’s shoes and support them in preparing for the social world.
  4. The relationship has the staff in multiple roles: companion, advocate, case worker, and therapist–without the therapy part. They make on the spot decisions, but include the “client” in the decision. The staff use this as a way to gain leverage in their field when they pursue higher mental health related degrees, and often have an interest in working with those in psychotic crisis. They are usually “psychologically tough, tolerant, and flexible” from lower middle class families with a “problem” member. MD’s are not in charge of the program.
  5. Staff prevent dependency and encourage “clients” to remain in contact with support networks. Clients may report feeling in control of themselves, and full with a sense of security.
  6. Access and departure is easy. Other than readmission, the clients have other means of staying in contact with the program: drop in visits, advice, or support over the phone. All clients are welcomed back once a week for an organized activity.

As a result, those who participated in this program remained socially involved, aware of the support THEY needed, rather than the support being shoved down their throat. They were given a sense of community, developed a sense of self, and that’s when the programs were shut down due to lack of funding.

Insurance companies and HMO’s refused to pay for something cheaper than hospitalizations, that promoted well-being and self-sufficiency without medication. Not to mention backed by extensive research, of which most hospital procedures and models do not have. They never will.

Conclusion:

What Mosher created was a Respite.

What we’ve further developed, upon the same principals with much amendment, are Peer Respites. However few and scattered they are, they exist, still with no big funding from major corporations or companies, nothing that would secure their existence as hospital’s have.

Rather than staff who have graduated with psychology degrees, Peer Respites are staffed with Peers: people who have swam in the deep pool of depression or swung high in the throws of Mania or slapped on that infamous tin foil hat to keep out the aliens. Whatever. I’ve never put Tin foil on my head, but I have wrapped myself in clear packaging tape to keep demons from scratching my skin. Close enough, right?

It didn’t work, by the way. I’m assuming the tin foil doesn’t keep out the aliens either, so I won’t try it. If aliens want my brainwaves, they can have them as long as they make me really good at math and whisper answers to me during tests.

Mini-Tangent over. I’ve forgotten what we were talking about.

Peer Respites. Not staffed by graduates, still not headed by MD’s, and still a community of quiet, supportive, community-based experiences. I have no clue how other’s are run, but the one I’m apart of has groups, outings (beach, hiking, whatever), trainings (for us), and a WarmLine: a phone number to call when you’re in need of support. It’s all very Soteria-esque, and also very modern. It gives those of us who are fortunate enough to “work” there a purpose, and a chance to be involved. Sometimes that means no more reliability upon disability checks. That’s huge.

Independence is encouraged: cook your own meals, wash your dishes, do what you need to during the day, call if you’re out late. We do meals together as well, everyone chips in–as much as some can–and no one is chastised if they can’t. Encouraged maybe, but never chastised. Humanity is a thing here, you see. A pretty big thing.

The wording as changed. For us, no one is a client: we have guests. We’re a house on a street in a neighborhood. We’re voluntary and self-referred. There’s no diagnosis, we don’t hand out medication, and we don’t judge if you’re on it or not.

The idea that humanity, kindness, and understanding is enough to support even the most “psychotic” person isn’t a new idea, you see. It’s just not one supported by the APA or Big Pharma. Most clinicians I’ve spoken with have never heard of such a thing, so it’s not spoken about in training, courses, or conferences unless those trainings, courses, and conferences are solely focused on Peer Support. Once again, not supported by the APA or Big Pharma. Can you think of any reasons why? I can think of a few dozen.

Were something specifically like Soteria to come back, it would be a game changer. To remove this idea that because you’re struggling, you need to be confined for your own safety and the safety of others only perpetuates this idea we’re violent, out of control, and unable to function in society. Not only does it send that message to the public, but it sends it to ourselves as well. And when we believe it, it comes true.

To direct people in crisis away from the system before they ever really become in contact with it, staffed and run by peers–that’s a dream in the making. That’s a recreation of Soteria. That’s a hybrid of Peer Respite. That would take a lot of funding. That’s been a goal of mine since I was 15. It’s been a passion since I learned Peer Respites still exist, and that the idea didn’t die with Soteria’s funding crisis.

It’s amazing what a little compassion can transform.

Links & Sources:

Soteria Review/explanation By Mosher

Bleurian Terminology and what schizophrenia was classified by

Mosher

Resignation letter (in case you missed it)

R.D Laing (Kingsley Hall)

A push against Psychiatry

The Peer Movement

The Social Construction of the DSM.

In the magical birth year of classical television series “I Love Lucy”, the DSM-I materialized into existence with 145 pages and 106 disorders.

Based off the Medical 203 (The Armed Forces Nomenclature), this 1951 piece of psychological literature featured short paragraphs describing disorders so psychologists and psychiatrists could look up at their patients dancing across the floor, look down at their trusty Bible, compare their patient’s behavior to their book’s description, and experience that “light-bulb” feeling.

In the medical 203, experiences later labeled as disorders were considered reactions to life, to combat, to habits learned in life from friends, family, social status and environment. The medical 203, you see, included LIFE as a source of altered mental state. What a radical view, right? LIFE and VARIETY being the cause of people’s experiences. So fucking radical I almost spit my juice across my computer screen.

The DSM-I followed those footsteps closely, with the guidance of APA president and first psychiatrist-In-Chief at John Hopkins University, Adolf Meyer. He believed, at first, chemistry and physiology could explain these mental experiences, but after findings in his own research and a glance into reality, he termed what we know as disorders today, as “Reactions”. He saw that emotional states were responses to experiences in life, and life in itself.

The DSM two, in the year of Martin Luther King Jr’s assassination, contained only 136 pages stuffed full of 182 disorders. There’s a rumor in the mental health community that the DSM evolved from “reaction” to “disorder” because of science–everything is always because of advancements in science, right? They found biological proof of mental disorders, right? They were mapping neurotransmitters and the dopamine hypothesis and the amygdala and the frontal cortex and inserted fancy terms and publicized research papers and they were experts after all . . . right?

The reason the terminology and the view associated with mental “reactions” was transformed stems not from science but from a really, really weak attempt at neutrality: Robert Spitzer and Paul Wilson stated they wished the DSM to stray from adhering to any “specific theories” when labeling disorders. Neurosis entered the scene, the term “disorder” reigned prevalent, and in the year 2017 we have the DSM-5, with over 300 disorders and a creative budget of 25 million dollars.

25 million dollars to write a book that’s been re-written four other times to basically say the same shit.

Why is ANY of this important? So I can ramble and make people read my rambles? That’s part of it.

The rest of my reasoning is far more valid. When Spitzer and Wilson reasoned the term “reaction” unworthy against “disorder” and descriptions of “neurosis”, what did they think they weren’t adhering to? The idea that people were struggling in life and therefore reacted to it? The idea that life itself might actually be a bit traumatic? The idea that there is a variety of human brains and human perceptions that could at any time differ from theirs? How is that a significant and scientific reason to dismember a mental health system that intertwined social, environmental, and biological factors? How is exiting the social and environmental portion of this not favoring AND adhering to a biological theory? 

So much for neutrality. 

Gender is a spectrum. This is 2017: Gender and Sex are not the same, Transvestite is not an appropriate term, and non-binary is a thing. We won’t go into the slander of the DSM-2 on sexuality, but we will talk about the transformation of how homosexuality and gender dysphoria was seen in those days versus today.

Because really the only thing that changed was the words. The natural variation of human sexuality and the development of sexuality in fetal stages has never changed: there have always been people who favored intimacy with the same sex over the opposite sex, and fetuses always went through the development process of splitting up hormones and growing certain organs.

Over time, the words changed and in the world of sociology, this classifies things like Gender, masculinity, and femininity as social constructions: no one is born a girl who likes barbies and no one is born a boy who likes toy trucks. At one point in history little boys wore dresses and blue was the color for girls: the ideas and standards we create and burden people with change as society transforms and time passes.

Over the last fifty years or so, How many names have changed in the DSM? How many descriptors have changed in the DSM? See where I’m going with this?

Who’s a good little social construction? Hmm? Who’s a good itty, bitty social construction! You, DSM! That’s right! Good boy!

A bold claim I don’t feel I need to defend, the reasoning defends itself. Abnormal and normal are social constructions: we deem what is “acceptable” behavior, what isn’t, and both categories change as time passes, as new generations gain empowerment, as older generations adapt. If the definition of eccentric behaviors, odd behaviors, bizarre behaviors are based on what is acceptable and not, they too change over time, and they too become social constructions.

Take paranoia around the government for example: all the people who were sent to a psychiatrist and called crazy because they felt some agency was reading their emails–well, in 2017 with the NSA in full-force, who’s crazy now?

This is not to invalidate our experiences or our mental states, only the way they’re being described.

What does it mean for these disorders to be social constructions? Am I saying they don’t exist and should therefore be dragged to the gallows and hanged for my mental health blasphemy?

Short answer: No.

Blunt answer: I could give two shits what someone’s disorder label is, just as I could give two shits if someone is gay, lesbian, bi, transgender, and all the other PC names I don’t know. I don’t even give a shit about my own disorder labels. I only care for someone’s experience, because that’s the only reliable thing in all of this. The APA isn’t reliable, the DSM isn’t reliable, medicine isn’t reliable; Medicine is susceptible to human error (and greed), the APA consists of elite, mostly white, cis-gender, non-crazy males, (meaning no representation for the majority of the world) and the DSM is a product of both of those.

But someone’s experience? That’s raw, that’s real, however unreal it may seem. I’ve never seen someone tell more of a truth about themselves and life than when their mental state is so vulnerable they have no choice in the matter–it becomes too much pressure to NOT share. And as morbid as that sounds, it’s also rather beautiful as these states allow us access to a portion of ourselves the hustle and bustle of modern life steals from us. We think deeper and we feel deeper. Sometimes we’re stuck so far inside ourselves we have no other option than to learn to love ourselves. Not many people have that opportunity.

Disorder (as of today) implies something is wrong, defective, shoddy. In another 100 years, it may mean something different. And when that time comes in 3017, when disorder holds a positive connotation, people’s experiences will still be raw, and real, and it still won’t matter how the term is perceived. Crazy, right?