Rethinking Psychiatry/Medical Model

For three days in December, I was fortunate enough to attend the Hearing Voices Facilitator Training held in Portland, OR. This training expanded my understanding of the voice hearing experience and equipped me with a number of tools to use in facilitating hearing voices support groups. Grounded in a feeling of community, the training was dynamic, emotionally therapeutic, and educational all at the same time – a crystal clear example of how support groups themselves might manifest in the lives of their members.

Readers respond to the New York Times article, “The Treatment of Choice,” about innovative programs for psychosis and schizophrenia that involve patients and their families in treatment decisions. “Narratives of success counter a drumbeat of faulty links of mental illness and violence, inaccuracies which serve only to further stigmatize and isolate individuals with psychiatric illness.”

An international group of researchers from multiple disciplines has published a historical, qualitative, and quantitative investigation into voice-hearing in women. The interdisciplinary project, freely available from Frontiers in Psychiatry, explores how sexism, exploitation, and oppression bear on women’s’ experiences of hearing voices.

Researchers from the City College of New York and Columbia University published a study this month testing the hypothesis that people diagnosed with schizophrenia treated long-term with antipsychotic drugs have worse outcomes than patients with no exposure to these drugs. They concluded that there is not a sufficient evidence base for the standard practice of long-term use of antipsychotic medications.

Listen: NPR’s On Point with Tom Ashbrook discusses the new book “Moody Bitches: The Truth About the Drugs You’re Taking, The Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy,” by the psychiatrist Julie Holland.

Benedict Carey at the New York Times covers the push for new programs that emphasize supportive services, therapy, school and work assistance, and family education, rather than simply drug treatment.

Children of parents who suffer from depression have a severely heightened risk of mental health problems, but new research points to several factors that seem to strengthen young peoples’ resilience and predict good mental health.

We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.

A new NIH-funded study suggests that children from low-income environments are more likely to have neurological impairments. The researchers claim that these neurodevelopmental issues are “distinct from the risk of cognitive and emotional delays known to accompany early-life poverty.”

Experiencing emotional pain is a necessary part of life. Emotional pain often contains valuable lessons to help us on our journeys. We need to make sure we are not numbing our hearts to those that are hurting. We need to de-stigmatize the struggles, joys and pains that come with being human. We need to not just mindlessly pursue happiness - though we might think of that as an inalienable right - and avoid pain. We need to do the only thing that brings true joy: embrace all of life and each other, as we experience together all that makes us human.

Recent meta-analyses of antidepressant clinical trials have revealed that up to 82% of the effects associated with the drugs may be attributed to placebo and non-medication factors. A new study examined the attitudes of psychiatrists toward these non-pharmacologic factors and found a large discrepancy between their beliefs and the empirical evidence.

In the context of the Silicon Valley suicides, one mother offers her story about her daughter. “It’s my premise that not only the culture of Silicon Valley, but also, almost more importantly, the nature of the remedies that are being proposed in the name of mental health counseling, are to blame in these deaths.”

Hugh Middleton, MD, Associate Professor at the School of Sociology and Social Policy, University of Nottingham, and NHS Consultant Psychiatrist, Nottinghamshire Healthcare NHS Trust has written an interesting and worthwhile book, “Psychiatry Reconsidered, From Medical Treatment to Supportive Understanding.” Dr. Middleton is co-founder of the Critical Psychiatry Network and this book could serve as the foundational textbook for our field. As his academic appointment would suggest, he has a decidedly social perspective on the kinds of problems that bring many people to a psychiatrist’s attention, but in this book he offers eloquent discussions of many perspectives that inform our field. It is remarkable that in this 200 page text, he is able to cover so many topics – diagnosis, pharmacotherapy, schools of psychotherapy - with such clarity.

An analysis of medical records in the UK reveals that the use of certain antidepressants for depression is linked to a heightened risk for mania and bipolar disorder. The research, published this week in BMJ Open, found the strongest effect for serotonin reuptake inhibitors (SSRIs) and the antidepressant venlafaxine.

A former pharma executive has broken ranks with the industry in a new book by reporting how multiple psychiatrists, schools, and his desperate hopes pressed him to allow higher and higher doses of antipsychotic medications. The result: his 15-year-old son's death from Seroquel.

In “When Phrenology Was Used in Court,” Geoffrey S. Holtzman writes for Slate about the spurious use of brain science in legal cases. In the 1800’s the “science of phrenology” promised to reveal criminal psychological traits by measuring the skull and today defense teams still employ neurogenetic explanations for their client’s violent behavior.

Critical psychiatry researcher, anthropologist and NYU professor Helena Hansen writes: “Opioid maintenance acts as a kind of pharmaceutical prosthesis which promises to return white ‘addicts’ to regaining their status as full human persons and middle-class consumers. Meanwhile, black and brown users are not deemed as persons to be rescued, but rather dangerous subjects to be pharmaceutically contained within the public discipline of the state.”

“If language is inherently unstable, then how can we hope to diagnose illness accurately?” asks psychiatrist Mark Salter in an article for iai news. “Naming things, abstract or concrete, is a form of categorization,” but, he adds, “it is important to remember that our categories say more about the categorizer than the categorized.”

In a major study, published yesterday in JAMA Pediatrics, the use of SSRI antidepressants during pregnancy was found to increase the risk of autism spectrum disorder (ASD) by 87-percent. Previous studies reveal that more than 13-percent of women currently use SSRI antidepressants during pregnancy.

“Some autistic adults have spent much of their lives with the wrong diagnosis, consigned to psychiatric institutions or drugged for disorders they never had,” Jessica Wright writes in The Atlantic.

Psychologist William Copeland writes for Mental Health Recovery that “bullying can occur at any age and the effects of which remain harmful long after the behavior has been endured.” “We, as a society, are just beginning to understand and come to terms with the havoc that bullying wreaks on the emotional lives of its victims.

A new study in JAMA reveals that, on average, 25% of beginning physicians meet the diagnostic criteria for major depression. In an accompanying editorial, Dr. Thomas Schwenk, added: "Everybody asks me, because of some of my prior studies, should we have more intense work in diagnosing depression in students? Of course, the answer is 'yes,' but how do you go about that without further stigmatizing them, further labeling them, further singling them out to even greater stigma? It's not just an issue of, 'Let's make better diagnoses and let's provide better treatment'; it’s more complicated than that."

Citing a 43 percent jump since 2003, researchers estimate that 5.8 million school-aged children and teens in the US now have an ADHD diagnosis, a staggering 12 percent of this population. The new NIH-funded analysis also found that the percentage of girls diagnosed with ADHD was up 55% and that the percentage of Hispanic children diagnosed shot up 83% over the same timeframe.

A new pro-recovery manualized intervention – called the REFOCUS intervention – has been developed and will now be evaluated in a multisite randomized control trials. The strengths-based intervention, which focuses on promoting relationships, is outlined in the latest issue of the British Journal of Psychiatry.

According to a study published in this month’s British Journal of Psychiatry, people diagnosed with depression in high-income countries are more likely to limit...