Rethinking Psychiatry/Medical Model

Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being. These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.

Since I left the psychiatric prescribing trenches and came south for the winter, I’ve been staying in a beach town within driving distance of a technology metropolis. I take breaks from my writing and walk to the beach. There, I meet and talk with the winners of the American dream. They are intelligent, highly educated and financially successful. They take their beach vacations here.

A reader asked why more psychiatrists don’t speak up louder against psychiatric drugs. I’d like to think there’s someone in charge who could sound the alarm. It’s nice to imagine that working doctors have the power and freedom to speak up in a forceful and visible manner. If such a doctor exists, it’s not a psychiatrist who works in the trenches. A working doctor today is not in a position to be Paul Revere.

Not long ago I had a conversation with a psychiatrist. He told me about a diagnostic dilemma he’d run up against at work; When a judge makes an unfunded treatment mandate as part of her judgment, she pressures the doctor to make a “payable” psychiatric diagnosis. If the doctor stretches the truth out of sympathy and provides an inaccurate but payable diagnosis so that his patient can have access to medical care and money to live on, he is committing fraud that can mean heavy fines and incarceration for himself.

In August 2010, my friend and fellow ‘suicide mum’ Deb Williams and I established CASPER – Community Action on Suicide Prevention Education & Research. CASPER’s goals are to provide peer support to families bereaved by suicide, to educate politicians and opinion leaders on suicide and its prevention and to support families and communities to reclaim suicide prevention from medical professionals and governments.

This is a transcript of my keynote speech at Alternatives 2012, which a Madness Radio listener recently transcribed.

My public writing has brought my mother and I closer together than we’ve been in decades. There have been disagreements. But now, my almost ninety-year-old mother tells me she reads everything I write. She recently told me that she’s glad I see things so clearly.

You may think I’m slow on the uptake when I say this. And maybe I am. But I recently came to the realization that products or lifestyles that are vigorously marketed and promoted are bad for you.

"Asheville psychiatrist Daniel Johnson didn't set out to transform his profession," says an article in North Carolina's Mountain Xpress, "But he’s now part of...

I am writing this post primarily to share a trailer for a new film. ‘Beyond the Medical Model’ is a product of our community in many ways. It grows collaboratively out of our hurts, our anger, our passion, our discoveries and our insistence that we be heard. Our collective wisdom and exploration drives its very purpose. It would be hollow without our stories.

“The voices, they tell me they gonna kill me, and it’s my fault.” “Sometimes, when we hear voices, they just reflect our own anxieties, sometimes they can echo things we’ve been told in the past. When the voices tell you that they’re going to kill you, does that echo anything you may have been told in the past?” I ask.

This is the second in my new series, “Haiku for social change”, the first having appeared on my own blog page. Since this piece is about pharmacology and psychopharmacology, I think MIA is a good home for it.

In my last post, I argued that the single most damaging effect of psychiatric diagnosis is loss of meaning. By ruthlessly divesting experiences of their personal, social and cultural significance, diagnosis turns ‘people with problems’ into ‘patients with illnesses.’ Horrifying stories of trauma, abuse, discrimination and deprivation are sealed off behind a pseudo-medical label as the individual is launched on what is often a lifelong journey of disability, exclusion and despair.

"We are in the process of turning the disease into the norm and where the normal becomes the exception. If this continues, we will...

Peter Kinderman, John Read, Joanna Moncrieff and Richard Bentall write, in Evidence-Based Mental Health this month, that "While some people find a name or...

We have just celebrated the anniversary of the rapidly expanding global Hearing Voices Movement which was founded more than twenty-five years ago following the ground-breaking research of Professor Marius Romme and Dr Sandra Escher. Romme and Escher have advocated for a radical shift in the way we understand the phenomenon of Hearing Voices; in contrast to traditional, biomedical psychiatry which views voices as an aberrant by-product of genetic, brain and cognitive faults, their research has firmly established that voices make sense when taking into account the traumatic circumstances that frequently provoke them.

by Eugene Epstein, Manfred Wiesner, and Lothar Duda Over the past 50 years, the psychiatric and psychotherapeutic discourses of the western first world have infiltrated...

Allen Frances, writing in the Huffington Post, calls the decision in the forthcoming DSM-5 to call grief in the bereaved a disorder as soon as...

I want to follow up my first post by outlining the principles of possible alternatives to psychiatric diagnosis – that is, alternatives in addition to the most obvious one, which is simply to stop diagnosing people.

Yesterday, Dr. Daniel Fisher emailed and asked my thoughts with regard to “recovery”. Even before I walked away from prescription-pad-only psychiatric work, others asked me about this. Other treatment providers, designated patients and family members asked what I thought they could expect to happen next and what they should do to make things better. I told them that chemical interventions are not the only, or even the essential, tool for recovery.

There used to be a wonderful cartoon series called 101 Uses for a Dead Cat, which led me 25 years ago to give a talk at a British Association for Psychopharmacology meeting entitled 101 Uses for a Dead Psychiatrist. That was back in the days when Psychopharmacology meetings were places of debate and the British Journal of Psychiatry was guaranteed to have something of real interest in every issue.

‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong - scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress.

Suicide needs to come 'out of the closet' as a public health issue. But this in turn requires a broad, ongoing community conversation rather than the current status quo of 'experts' talking about us without us. We also need to move beyond the excessive medicalisation of suicide that blames it on some notional 'mental illness'. This is my first post where I introduce myself, telling you a little of how I came to do a PhD in Suicidology. And an invitation to join me in a radically different conversation about suicide, here at Mad in America.

This past year has been a terrible year for mental health in the news and other media. The most prevalent and widely publicized messaging has been heartily encouraged by national lobbying groups that "advocate" for expanded treatment of what they have deemed "severe diseases of the brain." Psychiatrists and proponents of the medical model are calling for what is basically a soft re-institutionalization of people deemed mentally ill, particularly those with diagnoses erroneously assumed to be “treatable, but not curable.” This perspective is dangerous. It supports violence and abuse. It feeds fear and delusion. It is not helpful.

How is it that we allow the agendas of others to occupy our childrens’ minds? Is it possible that a stranger can know our child better than we do? Is there anything a baby needs to learn that can’t be taught by being held in a parent’s arms? Because my children’s eyes and ears and thoughts are on me every day, they are key players in my ongoing efforts to live a right life. I count on their eyes and ears and thoughts to shore me up during times of temptation. They always lead me home.