My new article on Mad in America about the price we all pay for our universal and core needs for empathy, compassion and love not being met in our wasteland culture.
My new article on Mad in America about the price we all pay for our universal and core needs for empathy, compassion and love not being met in our wasteland culture.
In this Psychology Today interview I share about how the work of Jung and Laing helped me through extreme states and still informs my therapy work with others.
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.”
A brief new article here about mental health providers who believe they never could suffer in the ways many of the people they serve experience, and how that belief limits the provider’s capacity for empathy and compassion.
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.”
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.
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.”
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.
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.