Medication Mechanization: Microchip Sensors in Abilify to Increase Medication Compliance

This entry first appeared at Mad In America on November 10, 2015.

I felt a chill go through my body when I read that the FDA has agreed to review for possible approval in early 2016 a new form of the drug Abilify that contains a microchip sensor capable of sending a message that indicates the exact time a tablet dissolves in the stomach. The message is recorded by a skin patch – along with data such as the person’s body angle and activity patterns – and, according to a press release from Proteus Digital Health, the developer of the device, “this information is recorded and relayed to patients on a mobile phone or other Bluetooth-enabled device, and only with their consent, to their physician and/or their caregivers.”

The Japanese drug giant Otsuka teamed up with Proteus Digital Health in 2012 to create this potentially profitable new “chip in a pill” just as its patent on Abilify – at $6.9 billion the #1 most profitable drug in the U.S. in 2013 – was set to expire in 2014, leaving one of Otsuka’s most valuable markets vulnerable to generics. It is especially ominous to me that our government is teetering toward passing the Murphy Bill, which would make forced in-home treatment the law of the land, at the same time it is lurching toward putting such an Orwellian device in the hands of a pharmaceutical company, courts, and families.

According to the Washington Examiner:

”The new smart drug could be particularly useful for ensuring the mentally ill continue taking their medications, not just by giving doctors a way to monitor their behavior, but courts as well…all but five states have court-ordered programs where a judge can mandate that offenders with severe mental illness stick with a treatment program as a condition of remaining in the community.”

As one Facebook commenter noted; putting a pill in your mouth and swallowing it, knowing it’s going to transmit a message to prove one is submissive and compliant, is beyond Orwellian – it feels fascistic. I agree. The social contract draws an invisible line that must be guarded against forces in a society that, driven by fears, fantasies of benevolence, or by simple greed, and are blind and deaf to the cries of its citizens as their bodily and personal integrity are ground into powder along with the preparations they are compelled to take in the specious name of “health” and “safety.”

Sometimes, radicalizing people politically takes a really callous, stupid, and dangerous threat to people’s liberty. This is one of those times.

The Washington Examiner article cites recent research that shows 74% of people who are started on antipsychotic medications stop taking them within 18 months. That’s the justification offered for a psych drug that monitors its own use.

“These individuals already have a history of problems due to their unwillingness or inability to voluntarily comply with treatment … this could be an important advance for them that would help them maintain treatment compliance.”

— D.J. Jaffe of the Mental Illness Policy Org.

Think about it: faced with the overwhelming 74% failure of a pharmaceutical intervention, why is the core issue deemed to be compliance rather than efficacy, and consumers’ safety & satisfaction? And why are we “gearing up” to ensure compliance in particular for a drug that even the FDA admits has an unknown mechanism of action?

What other medical specialty would blame its patients for so overwhelmingly choosing not to take the medications that have been prescribed to them? For a field that has taken on the charge of controlling and regulating social deviance, the ethical boundaries that the FDA should be protecting are blurred by the growing perception that people who are DSM-diagnosed are potential risks to society, despite overwhelming risk to the contrary; that a DSM diagnoses should be a signal that a person needs and deserves our protection.

Only a worldview that embraces the disease and deviance model of human emotional suffering would dare to suggest putting a sensor in a psychoactive substance to monitor and enforce its ingestion by an otherwise free citizen.

I believe that at some very basic level empathy seems to have failed in a society that sees the need to develop a sensor-equipped psychoactive substance. The blasé emphasis on prioritizing prescription compliance, without considering the profound subjective experience – to anyone, let alone a person in crisis – of having a digitalized foreign object inserted deep inside, an object that is in turn sending messages to an invisible outside presence. This oversight amounts to a vertiginous stumble forward in our society’s failure to muster empathy and compassion for its members, instead delivering them, in the form of a now-literally captive market, to the drug makers.

I’ve been seeing clients in therapy for over 35 years, and at no point can I imagine sitting a few feet away from a person in distress and suggest to them that they should consider having a device inside them that would let me know every day at a distance their most intimate experiences – let alone when they digest something, lie down, or when they have taken their meds. I couldn’t do it. It would feel ghoulish and perverse.

And I don’t want to be a part of a society that would do. Even – and perhaps especially – if it were being done “in my name.”

There is an aura of something shameful, a violation of a basic human right to privacy and bodily boundaries that is being ignored in the pursuit of this new digital monitoring of psychiatric medication. The shame is that, with a pill that records the moment of its absorption into our bodies, we are seeing the realization of a long-sought ideal of totalitarian governments; to cross the blood-brain barrier, gaining access to the very seat of our autonomy, and of our souls. With this, Otsuka could fairly revamp its marketing for Abilify by renaming it “Dis-Abilify,” without so much as risking – and potentially augmenting, in a society that seems to be exuberantly embracing an Orwellian ideal – its market share.

This is a time, if there ever was one, for citizens to act, and to act decisively; before the ability to make decisions, let alone act on them, is excised from our bodies completely by the next wave of pharma development.

Of course some will object to my characterization of those who developed this seeming well-meaning medical breakthrough as lacking a moral compass. But I have already heard the cries of outrage and fear from many of those for whom this Orwellian medicine is intended.

I’ll end here with an ever-more apt quote from C.S. Lewis –

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims, may be the most oppressive.”

Will Psychiatry’s Harmful Treatment of Our Children Bring About Its Eventual Demise?

sunflowergirl

This entry first appeared at Mad in America on March 8, 2014.

The safety of our children is a sacred obligation we strive to preserve. Anything or anyone that harms them becomes the object of our distrust and potential wrath.

I want to raise the possibility that psychiatry, for all its accomplished champions like Thomas Insel of the NIMH, may have forgotten the elemental fear people feel for the safety of their children. If psychiatry becomes perceived as a consistently increasing threat to our children, then are its days as a monolithic social institution numbered?

This essay was prompted when I recently had a pronounced visceral reaction of repulsion as I read about dozens of young children being subjected to new MRI brain scan research. Many friends that I shared this research with had a similarly strong negative reaction. The NIMH-supported research article, “Disrupted Amygdala Reactivity in Depressed 4- to 6-Year-Old Children,” was reported in the Journal of the American Academy of Child and Adolescent Psychiatry. The two experimental groups were described as “… depressed 4- to 6-year-old children and their healthy peers.”

The pathologizing process of diagnosing and labeling a 4-year-old child as being a clinically depressed research subject and therefore unhealthy compared to their peers, is done with the assumption that making that medical diagnosis is in the best interest of the child.

It is harmful to assume something is wrong with a young child’s brain when there is no doubt ample evidence that something has happened or is happening in the child’s life, that is causing them distress, to say nothing about the negative effects of a child receiving a DSM identity-transforming diagnostic label and being officially categorized as an exceptionally young mental patient.
Plus, what does a doctor tell a 4-year-old child before the MRI machine starts? “Please hold very still now, because we need to find out if there is something wrong with your brain.”

The children in this research on depression were also described as being “medication-naive.” None of them had been on medications – yet. If the word “naive” was instead used to mean that the children were innocent, then that would be accurate because a 4-, 5-, or 6-year-old child is indeed innocent and is helplessly at the mercy of the adults who decide what happens to them.

For over 30 years, I’ve known and worked alongside many child psychiatrists. They are some of the most dedicated and caring people I have ever known. When I would repeatedly protest to them about the dangers of prescribing antipsychotic meds and SSRI’s to children and teens, the psychiatrists often, with true anguish would respond to me by saying, “But Michael, I have to do it! The latest brain imaging research says that psychosis damages the brain, and it has been shown that depression is caused by a lack of serotonin.”

The solid, peer-reviewed research I would then offer, attempting to counter their biochemical, genetic-based, disease model beliefs, would unfortunately not be taken seriously enough to change my psychiatrist coworkers’ minds.

To no avail, I would urge them to consider that valuable scientific inquiry in the broader field of psychology doesn’t have to be limited to only studying genetics and the physical human brain. They shunned the evidence proving the efficacy of psychosocial alternatives to psychiatric medications. They seemed compelled to elevate applied neuroscience as a reified paradigm of understanding and treating human psychological distress.

It should be no surprise that almost all psychiatrists continue to believe what they were taught in their medical training, and believe what is affirmed in every journal they read about the future of psychiatry being applied neuroscience, and that they believe what is repeated to them by every drug company rep who frequently visits them with medication samples.

The path seems to be clear ahead for even more research on preschool children’s brains, because NIMH Chief Thomas Insel has a clear vision that he is determined to make happen. When he says, “The future of psychiatry is clinical neuroscience based on a much deeper understanding of the brain,” Dr. Insel means that his five-year plan called the Human Connectome Project, that will build a baseline data base for brain structure and activity using MRI imaging is leaving the DSM era of psychiatry in the dust.

The DSM is an embarrassment for a world class research scientist like Insel. But what he envisions is much more ominous for children and everyone else.
Insel’s leadership at the NIMH has the very strong support of forced treatment advocate, Dr. E. Fuller Torrey, who says of Insel: “He is the best director we have ever had.”

Insel and newly-elected APA President Dr. Jeffrey Lieberman want to preside over a new era of psychiatry where it gains the stature of any other medical specialty based on hard science. Insel and Lieberman want a research-proven genetic and biological basis for psychiatry, to qualify it as a fully functioning and respected clinical neuroscience.

Dr. Lieberman has recently said in The Scientific American, that vocal critics of psychiatry are “Misinformed or misinforming self-interested ideologues and self-promoters who are spreading scientific anarchy.”

Dissidents such as may appear on Mad in America are dismissed as scientific anarchists by the head of the APA, while President Obama and Congress are hugely bankrolling the new NIMH research on the brain.

The dramatic future for psychiatry envisioned by Doctors Insel, Torrey and Lieberman as a golden age of applied neuroscience appears to be assured.
Is psychiatry, as such a powerful monolithic social institution, truly “too big to fail?” Or is there a hidden vulnerability present in the proud edifice?

I wrote a blog here on MIA a couple of years ago called “I Don’t Believe in Mental Illness, Do You?” What that means to me is that I don’t believe in the centuries-long medical model project of pathologizing human emotional suffering that is the hallmark of psychiatry.

The medical model never satisfied my answers about the causes and healings from my own experiences of emotional suffering and madness, or spoke to me as a reliable guide in helping the children and adults I provide therapy for. If I did believe in the medical model, I would surely do what my child psychiatrist friends unintentionally sometimes do – I would risk harming innocent children while truly believing that I am helping them.

What we believe can dictate what we do. But surely our beliefs should not result in children being harmed.

The problem is, that the medical model belief system sets psychiatrists up to be blind to its harmful applications. Psychiatrists who did lobotomies and sterilizations convinced themselves according to medical model tenets, that such harmful procedures were necessary and in the recipient’s best interest. The fact that child psychiatrists in Australia will actually administer ECT to children under 4 years old, and that antipsychotic and antidepressant medications are given to toddlers in the U.S., is dramatic continued proof of how the treatments dictated by a morally numb psychiatric science are still failing to pass the caregiver litmus test of “First, do no harm.”

Blindly failing that ethical test means that psychiatry is clearly in the process of losing the moral authority to deserve our trust, especially as we learn more of how our children are at risk of being harmed.

So, I have come to believe in recent years that Dr. Insel’s vision and the incredible psychiatric social experiment of pathologizing human emotional suffering will ultimately fail, because psychiatry will continue to zealously and blindly cross a morally repulsive line and forget that a great many people will never accept their children and grandchildren being exposed to danger.
I believe that at some point, those continued treatment excesses with our children will finally cause the general public to lose faith in and simply abandon psychiatry, moving on to a new paradigm of care where the growing demands for safe and nonpathologizing alternatives are met.

The obsolescence of psychiatry may not happen in my lifetime, but you will see the tide turn even more in that direction when a first young blogger appears on Mad in America to proclaim, “I was diagnosed with bipolar disorder and put on antipsychotic medications when I was very young. Please understand, I was only four years old when they started injuring me.”

The Esalen Connection: Fifty Years of Re-Visioning Madness and Trying to Transform the World

This entry first appeared at Mad in America on December 12, 2013.

When Richard Price was a young man, he experienced extreme states for which he was labeled schizophrenic and forcibly ‘treated’ with psychiatric medications, ECT, and insulin shock. He suffered from residual effects from this for the rest of his life. In 1962, Price and Michael Murphy founded the Esalen Institute on the Big Sur coast of Northern California. From its beginning, Esalen worked to create sanctuary for people who, like Price, experienced extreme states. “Esalen was Price’s revenge on the mental hospital!” says Murphy.

Both at the institute itself and through the creation of projects like the rigorously designed, NIMH-funded Agnews Project research, Esalen helped to create the contemporary model of madness sanctuary. Agnews, which yet stands as the largest randomly-assigned, double-blind study on first episode psychosis, showed a 70 percent lower re-hospitalization rate advantage from providing a med-free environment for people in initial extreme states; a result which provided impetus and support for John Weir Perry’s med-free sanctuary Diabasis House, and the creation of the I-Ward sanctuary that I served at and wrote about here on MIA in “Remembering a Medication-Free Madness Sanctuary”.

dickprice
Dick Price

Dick Price also wanted Esalen to be the kind of outside-the-box think tank that could fundamentally re-vision the experience of madness away from the medical model vision. Price realized the applied practice of the medical model belief system was the cause of the greatest trauma in his life. Price said about his own experience that “The so-called ‘psychosis’ was an attempt towards spontaneous healing, and it was a movement towards health, not a movement towards disease.” He believed his experience of madness was not pathological but was full of meaning and was transformative, even perhaps touched with mystical power. He saw Esalen as a refuge for people in extreme states, “A space where it’s possible to live through experience rather than having it blotted out, a place where there aren’t the same negative self-definitions of someone going through this type of experience.”

In addition to Price’s commitment that Esalen provide refuge for those in extreme states, Esalen’s broader liberating influence on world culture would prove to be enormous, as pioneers in philosophy and psychology made it the birthplace and epicenter of the human potential movement. (Sascha Dubrul has written a great article here on MIA about the lasting relevance of the human potential movement for current activism.) The young and gifted Price and Murphy attracted figures like Alduous Huxley, Alan Watts, and Abraham Maslow, who helped put Esalen on the map with week-long and even month-long gatherings for re-visioning madness. Ongoing symposia with names like “The Value of Psychotic Experience” went on for the whole summer of 1968! Gregory Bateson, Murphy and Price, Alan Watts, RD Laing, Erik Erikson, Fritz Perls, John Weir Perry, Claudio Naranjo, Virginia Satir, Julian Silverman, Alan Ginsberg, Michael Harner, Joan Halifax, Stan Groff, and many others all contributed to a growing understanding of extreme states that continues to evolve, as it certainly always must. They saw a neglected possibility for humankind, rooted in a philosophy that has always served to bring a dimension of the sacred and numinous into view.

That ancient but always emerging mythic vision serves as a counterweight to the objectifying, pathologizing and materialistic world view that I believe makes the tragically narrow vision of psychiatry possible. Esalen’s role in altering the views and approaches to madness, or extreme states, continues to this day.

Last month, following in the tradition of passionately focused Esalen conferences, I organized a week-long invitation-only gathering there; “Alternative Views and Approaches to Psychosis.” This conference was preceded in 2011 and 2012 by a workshop and then a conference on alternative approaches to extreme states that began a revival of this aspect of Price’s work, one that had been dormant at Esalen since his death in 1985, when he was struck by a boulder while tending to the Esalen grounds following a flood.

This year, the Esalen conference was attended by 40 people involved in one way or another in the mental health revolution that is daily chronicled here on Madinamerica. People with lived experience brought their invaluable perspective to a gathering that included peer counselors, psychiatrists, therapists, authors, film makers, researchers, mental health services administrators and family members. A great many of the 40 people who gathered felt a sense of urgency to come up with collaborative, strategic ways to unite against the ever-growing human rights abuses of forced treatment. Those human rights abuses are being justified more and more in the name of protecting society from the suspected danger of people who have been given a psychiatric label. That public demonizing of those of us with lived experience of extreme states is being fueled by wide-scale fear mongering and draconian laws that threaten all who experience extreme states.

A number of us at the Esalen gathering committed to work together to fight human rights oppression on many fronts, via media, public education, legal campaigns, and expanding on existing – and developing new – humane, alternative supports for those in extreme states.

Dick Price was a psychiatric survivor whose compassion still touches us now. I know I wouldn’t be writing here on MIA if not for him, because the I-Ward medication free extreme state sanctuary I went to work at in 1980 would never have existed without the Agnews research Price made happen. John Perry’s Diabasis House – that I did my doctoral research on – never would have existed either.

So, thank you Richard Price, for fatefully touching my life, but so much more for helping so many people in extreme states receive the love you were denied in your hour of need, and escape the soul-shrinking diminishment of self-worth, and the hopelessness that a psychiatric diagnosis can inflict. Esalen lives on as an example of what can happen – for individuals and for society at large – when we respond to the extremes that sometimes come with human life not with fear and control but with receptivity and encouragement. There’s no knowing – ahead of time, at least – how much accrues to each of us and to society at large when we learn to listen to the voices – weak, tenuous, or frightening as they may sometimes be – of people who are struggling with the process of coming-to-be in a world that often silences or eliminates them before they have a chance. Dick Price’s voice was silenced early but lives on in the place in which he came to live and die; a memory and evidence of what can happen when the best of mind, body, spirit and community are given a chance to come together.

Photo ID Cards for “Mental Patients” Now a Reality

This entry first appeared at Mad in America on October 29, 2013.

In Butte County, California, Law Enforcement and NAMI have recently partnered to provide identification cards for people in the mental health system. The cards reveal the person’s psychiatric diagnosis and current medication prescriptions. The voluntary photo ID cards are called ‘White Cards.’

The goal is to help law enforcement have on-the-spot psychiatric information, about someone they are questioning. The local NAMI president explained the ID cards also include a person’s triggers, like . . . “If you get too close, I get violent.”

This White Card project may be well-intentioned, but it makes me very uncomfortable. I believe it is a form of psychiatric profiling that could be adopted by law enforcement around the United States, with the powerful political backing of NAMI, and the tacit if not public support of psychiatry.
The operative stigmatizing equation appears to be “mental patient” = unacceptable danger to others. Will police believe that “good,” compliant and NAMI-aligned “mental patients,” who will be able to show the police a White Card with their diagnosis and prescribed medications, make up a lower risk group, than people without a White Card, who reject being identified by a diagnosis, and may not be taking meds?

Will people without White Cards be seen as potentially more dangerous by the police?

And won’t the police eventually want a data base of all White Card holders to cross check against when someone hands them a White Card, creating a kind of watch list?

I can imagine staff at psychiatric hospitals pressuring confined people, to sign up for a White Card as a new and added criterion for their discharge.

I can imagine staff at mental health clinics urging people who are court-ordered to receive forced treatment in the community to also get a White Card.

The cards can be obtained at a NAMI office, or at the police station.

Supplying people with “mental patient” identification cards, conveys the implication that something is proven, that predicts a person’s behavior about potential violence, whereas the state of the scientific research, cannot support such an ID card project aimed at violence prevention. It ends up being psychiatric profiling – a whole class of people becomes the socially identified scapegoat, based on the fears and projections of others. Once again we see the psychiatric diagnosis process serving as a public degradation ceremony, that effectively strips personal identity away, to legitimize the enforcement of the regulation of deviance in our communities.

This White Card project is happening against the backdrop of over 40 states oppressing people with forced, in home treatment laws.

Draconian measures imprisoning and forcibly medicating and giving ECT to people, are challenged now by the UN, which equates forced psychiatric treatment with torture, as Tina Minkowitz has so well documented here on Madinamerica.

This joint Law Enforcement/NAMI White Card project looks to be another ominous development to me.

Your thoughts?

White Cards Aim to Ease law Enforcement Interaction With Mentally Ill in Butte County

Does The Psychiatric Diagnosis Process Qualify as a Degradation Ceremony?

This entry first appeared at Mad in America on September 7, 2013.

There is liberating power in naming something for what it really is. It is a freeing act of defiance. The psychiatric diagnosis process is a degradation ceremony. Shock treatment is a human rights abuse, water boarding is torture, etc.

The functionaries assigned by society to control deviance have an enhanced status. In the case of psychiatry, they have even been entrusted by society to define deviance in their echo-chamber diagnostic manual.

Whether they personally experience the act of diagnosing/degrading another as elevating them during the diagnostic ritual or not, they serve as deviance police for society and are very well rewarded for doing that.

But some of us defiantly say no. No more diagnosing/identity robbing, no more taking away our identities with the blessing of society.

Sociologist Harold Garfinkel, in his landmark article “Conditions For a Successful Degradation Ceremony” wrote that “Degradation ceremonies are those concerned with the alteration of total identities.”

I first read this liberating article in the 1970′s as I was trying to piece together my life after a lengthy experience of madness. It validated my gut-level belief that my avoidance of psychiatric treatment, no matter how much I was suffering, was necessary to avoid having my identity stripped from me and a new identity of life-long mental patient embedded in my psyche.

Garfinkel was greatly influenced by Erving Goffman, the father of Labeling Theory. Goffmans’s book Asylums: Essays on the Social Situation of Mental Patients and Other Inmates looked at how society deals with deviance by codifying and enforcing social roles and identities.

But Garfinkel’s work on what he called “Status Degradation Ceremonies,” is very appropriately geared to help uncover more understanding about the impact of the process of psychiatric diagnosis.

Because I believe that undergoing a psychiatric diagnosis process has an uncanny and sinister-feeling quality to it that comes from a deeper aversion than just forming a rational objection to being labeled and subjected to a DSM-5 category.

I think our deep aversion to being diagnosed comes from a fundamental reality; that psychiatry has been invested with the same power to perform identity degradation that has always resided in designated specialists. “It will be treated here as axiomatic that there is no society whose social structure does not provide in its routine features, the conditions of identity degradation,” says Garfinkel.

When we are diagnosed, we feel the weight of an ancient social sanction of identity degradation, one that has taken many forms from our tribal beginnings, but is still life-transforming in its power – even when carried out now with the best intentions, and for our perceived benefit by mental health professionals.

Garfinkel points to this almost archetypal human experience when he writes, “Just as the structural conditions of shame are universal to all societies, by the very fact of their being organized, so the structural conditions of status degradation are universal to all societies.”

The crushing loss of faith in a happy future is profoundly damaging because of the loss of our personal sovereign identity, a rupture occurs in the personal continuity of who we were before we were diagnosed, with who we are said to now be.

Garfinkel asks, “What program of communicative tactics will get the work of status degradation done?” A ceremony is required that will secure the product of successful degradation work to be a changed total identity.

A professionally rendered DSM-5 Axis 1 diagnosis always rests on the belief that a bio-genetic disease process has been established to exist. The diagnosed person is informed that their illness should be of primary concern indefinitely, if not for the rest of their lives. From that fateful day of diagnosis forward, the person shall now be officially identified as someone with a major mental illness.

For Garfinkel, the person undergoing a status degradation process also “must be placed outside, must be made strange,” and must become “literally a new and different person. The former identity stands as accidental; the new identity is the ‘basic reality.’” What the person is now is what they were “all along.”

But I learned there is a way out of this trap. There is good news. As so many readers of Madinamerica.com can testify, we can “render” all degradation ceremonies “useless.”

When I read the last line of Garfinkel’s article almost 40 years ago, it felt like a jail break to me, because it said I could – with a very simple move – render useless any attempt to pigeon-hole me and take away my identity via a psychiatric diagnosis.

I could simply choose to not acknowledge or honor the socially-sanctioned power of psychiatry to perform a degradation ceremony on me.

Because unless we volunteer to give that power to another person or our society, they can’t wield it.

Oh yes, they can diagnose us, lock us up and do all the human rights abuses they do that they call treatment, but if we refuse to give away our identity, no one can take it from us.

If the social institution of psychiatry is tasked by our society to regulate deviance via the identity degradation ceremony of diagnosis and oppressive “treatments” that are often human rights abuses, then how can such a dysfunctional, dystopian society find its way out of such a spiritually and morally bankrupt cultural dead end?

Can Garfinkel’s baleful pronouncement that all societies inherently are set up to have identity degradation ceremonies take place be flipped, and we claim that our society can and must also be a constant source of an opposite kind of ceremony that we pursue doing status elevation ceremonies, identity valuation ceremonies?

As individuals, we can refuse to give psychiatry the credence or moral authority to perform a successful identity degradation ceremony on us.

But how can our individual defiance reverse the ubiquitous practice of diagnosis/identity degradation?

Briefly, I will just say, as I approach 70 years in our Orwellian dreamscape, that I don’t look to social institutions like the law, religion, academia, political ideologies, or the media to save us from the societal dead end we inhabit.

The collective horsepower to take back our culture from its blind masters resides right here on Madinamerica and on every psych ward and in every prison yard.

That transformative social power was present in the anti-war and social protest movement of the 1960′s, and the recent Occupy movement, the civil and women’s rights and LBGT movements, and our mad pride/consumer/survivor/ peer/recovery/human rights movement.

Our ceremonies of self-love and love for each other as comrades, and the ceremonies of open defiance we practice together, don’t mean the tragic fruits of rampant anarchy will replace the identity degradation ceremonies and human rights abuses that are masked by medical legitimacy.

Revolution is the word and the answer and it always has been. It is the sure path to personal and societal freedom and transformation. If we listen to our hearts and not so much to our heads, the right direction will keep being shown to us of how to proceed.

Imagine a society where one day psychiatric diagnosis and identity degradation ceremonies don’t happen any more. Like John Lennon sang: “It’s easy if you try.”

Why Involuntary Out-Patient Treatment Isn’t Necessary – A First Person Account

This entry first appeared at Mad in America on August 2, 2013.

The last sentence in a recent New York Times article entitled “Program Compelling Outpatient Treatment for Mental Illness is Working, Study Says” tells of the police taking a man to get his monthly Haldol injection under the involuntary treatment law.

For years I worked on a community based team that helped homeless people in extreme states who had histories of being frequently hospitalized.

I met them wherever they lived – on the streets, under bridges, in abandoned buildings, and in parks. I formed close, trusting connections by being open-hearted and harmlessly helpful. I wasn’t trying to “treat” them or enforce medication compliance.

Many people made remarkable changes because I had truly befriended them, pursued them with compassion to where they lived in isolation, helped them get food, wash their clothes, find safe housing.

It breaks my heart to see that police-state tactics such as forced Haldol injections are understood to be the only thing that can reach some people. I know it isn’t true.

I remember the supervisor of our county hospital psychiatric emergency unit contacting me, because a long-time homeless man who I was helping, hadn’t been there in over six months.

He had been the most frequently-hospitalized person in our large county mental health system. He often had been brought to psychiatric emergency by the police – sometimes several times a month. He had spent long months in the state hospital.

The supervisor really couldn’t understand that my simply spending time with him on the streets almost every day was making the difference.

But it was.

That simple friendly contact – when we are not forcing anything on someone, but instead are harmlessly helpful and kind – is precisely what helps someone relax and choose to pursue the basic things they need, like food, clothing and shelter.

But more, that frequent time spent with me simply listening and warmly feeling concern for the homeless man, began to gradually reduce the intensity of the extreme emotional state he usually was in. He became more and more present in the moment, more lucid and at ease.

That gradual shift into a more focused and relaxed state, has happened with many other people in extreme states that I have spent time with in that heart-centered way over the past 35 years.

You might want to see one of my related MIA blog essays, “Responding to Madness With Loving Receptivity: A Practical Guide.”

I hope that our society doesn’t persist in the fear-induced reaction that forces people in our communities who are experiencing extreme states to experience violations of their human rights as well.

It’s not right, and It’s not necessary.

Are Some Psychiatrists Addicted to Deference?

One of the subtle but underlying factors that keep the great divide active between psychiatry’s medical model of human emotional suffering, and the alternative paradigm that challenges it, is the existence of a class system based on meritocracy, that accounts for some of psychiatry’s rigidity in considering an alternative paradigm position. The credible research that supports such an alternative view is often ignored, which is inconsistent with the scientific method that psychiatry claims is the legitimizing foundation of its theory and practice. I’m offering a partial explanation of why such valuable research is ignored.

My remarks here are based on working side by side, every day for over 30 years with my friends and colleagues who are psychiatrists. Some of them seemed to suffer from what I would, in good nature at times describe to them, as an addiction to deference!

Most psychiatrists come from middle class backgrounds and have accomplished a huge feat to get an MD and to practice psychiatry. They are accorded deference in a professional hierarchical class structure based on merit, that reflects another way that our classist society stratifies itself.

Their daily and decades long experience is that every nurse, secretary, and other mental health professional in every clinic and hospital, will defer to their judgment and authority, due to their status and more advanced degree and license to practice medicine.

The medical settings where they work positions them at the top, in terms of pay and status and authority, and the huge power to prescribe medical treatments that are exclusive to their profession. Sometimes these treatments can only be done on a doctor’s order, such as ECT, forced and voluntary medications, and restraints.

Having worked along side psychiatrists everyday for all these years, I can only say they have always been shocked when I did not defer to them.

They would want the last word in every decision about every treatment they authorize or drug they prescribe with “their patients,” as they proprietarily call consumers, because they believe their license requires them to take sole responsibility for the quality of care given.

When necessary I would not give them the last word. I hold my obligations to the people I serve as an ethical and sacred trust too.

From decades of experiencing psychiatrists’ reactions to me when I would professionally, and while showing them all due personal respect, not defer to them about decisions that effect the consumers I served, I learned that a huge obstacle to the honest debate that non-psychiatrists would have with them, is caused by the fact that such questioning of a psychiatrist’s theory, research and practice is so often experienced by them as impertinence.

In those 30 years I was almost always the only professional I knew who openly and consistently would not defer to them if need be. It slowly occurred to me, that a regression to the psycho-familial grips a great many psychologists and other professionals in the field, when faced with the psychiatrist’s expectation that they should defer.

The old adage that children are to be seen and not heard, feels like the unspoken message, and in fear of surrogate parental anger, a child-like regression seems to block some adult care givers from speaking up with psychiatrists.

There are real time consequences for other professionals challenging the psychiatric authority that claims an absolute position of superiority in the meritocracy hierarchy. That hierarchy replicates the power dynamic we experienced with our parents.

In addition to serving consumers 40 hours per week for 30 years, I believed that part of my service as the elected president for 16 of those same years, of my 250 white collar union mental health staff unit, was to embolden co-workers to question authority and stand up for themselves and the rights of the consumers we served. As human rights activists, we needed to do that with mental health system administrators and politicians as well.

Sadly, only a handful of my co-workers were consistently able to speak truth to power.

So, if you are a psychiatrist reading this now who probably never has experienced any response but being deferred to for the reasons I have given, you may feel like the psychiatrist who glared at Bob Whitaker all through a presentation Bob was doing, that I heard him report about at a conference.

As I heard Bob’s telling of the story, it went something like this- the glaring psychiatrist approached Bob after his presentation. Bob was hoping for a forthright exchange about the research issues that he had offered for consideration. The psychiatrist instead said something like, “I came up to tell you that I am not interested in your ideas or to discuss them with you. I just want you to know this Mr. Whitaker, I do not like your attitude.”

This exchange with Bob, captures the feeling tone of all of those times I would respectfully challenge the stated opinions of psychiatrists, as for example, when I witnessed them telling many consumers I served in therapy, that they had a life long, genetic based brain disease, that would require them to be on medication for the remainder of their lives.

First things first. Don’t defer to anyone who says what you do not believe to be true.

First published at Mad in America.

Scientific American | DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice

DSM5

In this amazing, over-the-top rant by Dr. Jeffrey A. Lieberman, the new president of the American Psychiatric Association, he contemptuously denounces activists who openly challenge psychiatry as being “misguided and misleading ideologues and self-promoters who are spreading scientific anarchy.”

I believe his aggressive rant proves we are making progress, in raising public awareness about the human rights abuses done by psychiatry.

DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice

An Integrative Approach To Transformative Madness

October 17th, 2011
The Icarus Project Speaker Series
The California Institute of Integral Studies

An Integrative Approach To Transformative Madness

Michael Cornwall, Ph.D.

Much Madness is divinest Sense–
To a discerning eye–
Much sense–the starkest Madness–
‘Tis the Majority
In this, as All, prevail–
Assent–and you are sane–
Demur–and you’re straightaway dangerous
and handled with a chain.

– Emily Dickinson

Here are some thoughts that I wanted to share with you about how to best serve your clients, friends, and loved ones who are experiencing a psychotic/visionary experience. These thoughts will also be of help in doing self-care if you are entering or traversing a madness process.

These suggestions are mainly gleaned from my own unmedicated, untreated experience of madness in my early twenties, and from working daily as a primary therapist for almost 30 years with actively psychotic clients using a Jungian/Transpersonal, Laingian approach.

During that time I worked for over three years at a 24/7, alternative, 20-bed, free-standing, transpersonally-oriented, acute care open door program called I-ward in Martinez California where no medications or leather restraints were used or diagnoses given to consumers who were acutely psychotic.

I also helped develop a similar five-bed program in Marin County, Passages In, that was short lived. I did several months of internship at St. George’s Homes in Berkeley where a similar Jungian/Transpersonal approach was used.

After that I worked for 25 years in public sector clinics and on a mobile crisis team as well as in private practice. Even in those settings, most of the psychotic clients I served were not on medication.

I also am drawing on my doctoral research follow-up study done on the San Francisco-based, medication-free Diabasis House for clients in acute psychosis and my 25-year relationship with its founder, Jungian psychiatrist John Weir Perry.

But my early experience of serving from age 18 as a medic in the Army Reserve for six years and then as a State Hospital attendant with profoundly retarded men and for two years as an orderly at a nursing home with brain damaged, demented and Alzheimer’s patients also informs my advice on how to relate to people in pain and suffering.

So, here are two basic principles for helping someone or yourself in a psychotic/transpersonal process which are distilled from my own experience and the study of successful Bay Area alternative programs.

1. Keep suspending your disbelief

Every time you tell yourself (believe that) the psychotic person you are being with has a tragic, lifelong, and threatening physical illness that has no inherent meaning or purpose – such as an injured brain, a genetically based diseased brain, an incurable thought disorder, or chemical imbalance – suspend your disbelief that another explanation may be possible.

Instead, hold the belief that they are going through a necessary, meaningful, developmental, initiatory, transformative, transpersonal/archetypal, symbolic and/or purposive natural process – one that is neither pathological nor indicative of a bio-medical brain disorder.

Hold the belief that, as Dr. Karl Menninger said, they might even come through the process “Weller than well!”

2. Be Receptive

Once you are able to stay open to the possibility that this person’s process is an important, potentially transformative natural life event, draw on all your skills of receptivity and empathy in order to be with them. Begin by simply listening and receiving the person with an open, compassionate heart. Let the gentle feelings of love that you would feel for a loved one who is frightened and suffering be present within you.

As their process unfolds, gently invite and encourage the person to express both the emotional and symbolic content of their process. People in a psychotic process may need to use modalities such as drawing, painting, movement, and evocative music to express themselves in addition to or instead of speech. Somatic modalities of touch and bodywork can be especially welcomed and grounding and soothing.

The common and overwhelming evidence from Diabasis, I-Ward, Soteria, and every other alternative program from all over the world confirms the basic need for a person in such a psychotic/ transpersonal process to be believed in, listened to and lovingly received and responded to in this way.

Today I also wanted to share some observations I slowly learned for myself the past 30 years about how to more specifically make yourself available to the person in the room with you who is in a psychotic/transpersonal process.

To be most helpful try and feel like your inner subjective state is more emotional than mental.

Create a physical and emotional state of receptivity. Let warm feelings of caring be present in you.

With your feet flat on the floor, hold the awareness that there is now a solid base and foundation beneath you.

Remember to keep your anal sphincter relaxed.

Keep a focus of energy in the hara chakra below your navel.

With your stomach muscles relaxed, feel yourself do deep and slow belly breathing.

Drop down your shoulders.

Let your face become calm and relaxed–not becoming pensive or quizzical.

Let your voice come up from your hara in lower octaves, emerging with the energy of your heart chakra as you speak..

Let your kindly, gentle, even loving and tender feelings of empathy and compassion arise in your heart chakra for a fellow human being in distress and suffering who is sharing the room with you.

Allow silences.

Don’t seek direct eye contact if it seems to make the person uncomfortable.

The person may be in a very heightened state of awareness and is processing minute inflections in your voice and body language.

Their ability to see into you may surprise you as uncanny and psychic.

In this state they may directly or symbolically tell you secret things about yourself that are disquieting.

If the person is hostile increase your vigilance on your own physical and emotional markers of receptivity.

Because you may find that you may involuntarily be holding your breath.

You may notice your throat becomes constricted and your voice goes up in octaves.

You may notice you are opening your eyes very widely and blinking a lot.

You may feel the need to fold your arms across your chest or cross your legs.

To the degree that you can be aware of these shifts in you prompted by anxiety, you can refrain from them as much as possible and remain in the open, receptive, emotional, and physical posture with a potentially physically or verbally assaultive person in a psychotic process.

The more you stay grounded and centered the more they will calm down, will not sense a fight or flight visceral response to them building in you.

Being with agitated clients in a psychotic process is kind of like practicing an internal martial art at times – a form of Aikido.

To give yourself the best chance of staying open and receptive be realistic about real danger to yourself.

Have another person keep an ear open and check at your door if you are meeting with a hostile person.

Position your chair by the door if with an agitated person to allow quick exit if you are attacked.

Give yourself the intentional permission that if necessary to survive a physical attack you will struggle to defend yourself in a way that would cause the least amount of injury to your self and to the other person until help arrives to contain the situation.

Madness is an ancient form of uncivilized wildness.

If you are given the opportunity to serve those traversing it’s mysterious depths and heights count yourself lucky, especially if they are not emotionally anesthetized by medication.

The efficacy results from the Agnews Project, I-Ward, Diabasis, and Soteria House all clearly demonstrate that without medication, most acute psychotic/visionary crises will in fact be the occasion for a life changing spiritual transformation if a 24/7 alternative, non-medical model sanctuary is provided.

My experience and research into alternative approaches for serving those in a psychotic/visionary process has led me to believe that that at least 50% of the consumers who become trapped in the mental health system could have avoided that fate if acute care, 24/7 Bay Area sanctuaries like Diabasis House, Soteria, and I-Ward (where I worked) were available at first contact with the system.

They never would have gone on to be labeled Schizophrenic.

Jung said that: “Psychiatry has turned the Gods into diseases.”

Unfortunately Jung and most Jungians have turned the Gods (and Goddesses) into archetypes: named and minutely described denizens of the collective unconscious that we can have an ‘as if’ relationship with at weekend workshops and schoomze with once and a while in our dreams.

Please don’t make the mistake of underestimating the spiritual dimension of our human birthright as you enter your own shamanic vocation.

In my experience, behind every image, thought and word, there is an emotion first. Behind every emotion there is a universal archetypal power and emotional energy that must come forth as imagery that expresses that deep emotion. Behind every archetype is a totally autonomous living force of deity that has no historical bounds, no time bound form.

These ancient and emerging deities, that use our lives and bodies as their playgrounds and every second hold us in sway as they incarnate themselves in us, ever emerging anew, arise out of a greater unifying mystery of benevolent silence.

Weep for the prophets and so-called psychotic visionaries who are robbed of their life giving gifts from the Gods by our culture of fear and human arrogance. And weep for us that we still treat them as lepers when they are, and always have been a divine source of the mana we need to survive on earth.

As a psychotic process begins, the psyche is faced with such overpowering unbridled emotion that the inner emotional charge grows to become profoundly existential in nature and magnitude. As the person faces the initiatory challenge of young adulthood in such an all pervasive liminal depth, the ego, the frail manager of consensual reality, simply is engulfed by the soul depth liminality of an emotional power that triggers all forms of desperate, seemingly delusional attempts to give some fragmented sense of meaning to the inner experience.

It is a visceral, first chakra existential experience that seizes the individual. It is the emotional response to being lost. It may be experienced mainly as one feeling exalted and indestructible at first or feeling totally doomed and bewildered.

The experience may also fluctuate between being plunged into the underworld and being drawn up into heavenly realms with amazing rapidity.

In any case, if not made numb by medication, the psyche creates a mythic story along predictable lines. The drama is played out on the stage of the central archetype, the Self, where every kind of polarity may be experienced and transmuted: good/evil, dark/light, male/female, life/death, terror/serenity, grief/joy, desolation/birth. All the emotion generated and image fueled polarities may be contained in the mandala crucible of the relationship you create with the person who is mad. In that container with you, all the polarities can be balanced into a cohesive unity.

That relationship with you is crucial, is a prerequisite for transformation and healing to occur.. Without a loving other to make the mandala crucible forged of their two hearts and psyches, the mad person spins on out of control.

Psychosis is the ultimate identity crisis and is for some, a potentially shamanic initiation. Our feeble, arrogant egos usually assume we are master of knowing “Who am I?”

As the pre-psychotic/visionary ego floats in this ignorant vulnerability over an abyss of the unfathomable depth of the collective unconscious and spirit world of gods, demons and ghosts, the ego is always just a few nights without sleep away from psychosis, or a drop of LSD away from psychosis, or from a psychosis triggered by a kundalini eruption, or a loved one’s sudden death.

The unprepared ego of an especially vulnerable young adult facing autonomous functioning separate from their family is at risk from drowning in the depth of the affect and images of the collective unconscious.

It is remarkable that the childhood tasks of such a vulnerable ego do not overwhelm it. However, in the late teens and young adulthood comes the awareness of mortality and the knowing that physical survival and social acceptance and success depend on functioning separately from parents.

Because of the power of our toxic and soulless culture to create enormous deficits in our family systems, most notably an epidemic of the lack of a strong infant-parental love bond, when faced with the often cruelly threatening social Darwinism cultural gauntlet one must traverse into young adulthood, the pre-psychotic ego for some is simply not prepared to traverse the hero’s journey and initiation across so much underlying liminality.

We can’t underestimate the corrosive and pervasive effects on vulnerable children and young adults that our largely loveless and spiritually barren corporate culture inflicts through degradation ceremonies of endless winner-loser competitions where shame and guilt and punishment break the spirits and hearts of so many.

For such vulnerable young persons, an affect of an unnamed existential terror, the dreadful sense of an abyss of yawning ontological insecurity seizes them. This overpowering challenge may then trigger an attempted visionary alternative restructuring of the ego through a radical immersion in a mythical inner struggle for adult independence.

This inner heroic struggle for ones future life is carried out at the archetypal center of the Self, if the young person’s process is not aborted, if they are given sanctuary and not medication.

I have seen them come out the other side with a new, heroic ego strength that grew out of their trial by fire.

As the great R.D. Laing said after witnessing and attending many on such a journey at the Kingsley Hall sanctuary he provided:

‘From the alienated starting point of our pseudo-sanity, everything is equivocal. Our sanity is not true ‘sanity.’ Their madness is not true ‘madness.’ The madness that we encounter in ‘patients’ is a gross travesty, a mockery, a grotesque caricature of what the natural healing of that estranged integration we call sanity might be. True sanity entails in one way or another the dissolution of the normal ego, that false self competently adjusted to our alienated social reality; the emergence of the ‘inner’ archetypal mediators of divine power, and through this death and rebirth, and the eventual re-establishment of a new kind of ego functioning, the ego now being the servant of the divine, no longer its betrayer.’

©Michael Cornwall, Ph.D. 2010