Rethinking Psychiatry/Medical Model

"Western psychiatry is in crisis." Not just our words, but the opening line of the powerful recent statement by Mental Health Europe (2013), a large and respected umbrella organisation representing both professionals and service users. It goes on to deplore "the simplistic and imposed application of … reductionist science" which can "encroach on basic human rights." In this post we examine the ways in which the profession of psychiatry is, in the UK, re-positioning itself in response to the widely-acknowledged threat to its power and status arising from the DSM-5 debacle and the ongoing failure to find the biomarkers that will confirm its theories.

When we share our stories publicly, whether in speaking, writing, or another art form, we acknowledge we are part of something bigger. We are aware we aren't the only ones who have been abused or witnessed abuse, or who are scared to let go of our ancestral shame and fear. We are, rather, part of an entire generation, an entire society that is moving away from silence, blame and abuse. In sharing our stories, we instantly recover from a big hunk of loneliness, loneliness that might not be so easily resolved sitting in a room across from a professional, with a few non-offensive art pieces on the walls. We acknowledge that every single one of us who experiences physical or emotional symptoms is holding onto things for others, in our bodies, and together, word by word, we can break free.

On the 6th of June 2013, ITV's This Morning hosted the News Review. One story was about the actor Stephen Fry and his recent publicity on how he has battled with his ‘bipolar’ condition and suicide attempts. While we don’t have any issue with this and the important message Mr Fry was trying to put across, we do have grave concerns over the comments made by the two guest speakers, and with what was imparted to This Morning’s vast susceptible viewing audience.

If we believe that emotional problems are primarily disorders of the brain, then perhaps taking a “fill-in-the-blank” medical history is sufficient. However, if we believe that emotional crises and dis-ease are problems that exist between people, in our sticky or not-so-sticky web of relationships, then whether families, survivors and those in crisis can heal together is a much more relevant, if still complicated, question. Perhaps the most honest answer to this question is: “It depends..."

If I'd known then what I think I know now about our overuse of psychiatric medications (and all the words we were using to dehumanize people and their experiences), what would I have done differently? Was my occasional reference to recovery hollow? Once I get beyond my increasing regrets and start trying to imagine steps I could have taken, here's what I would do.

<iframe width="560" height="315" src="//www.youtube.com/embed/CUuyzoTI948" frameborder="0" allowfullscreen></iframe> Thomas Insel's TedEducation presentation. "Today, thanks to better early detection, there are 63% fewer deaths from heart disease than...

Fireworks and heated debate were expected by many when Robert Whitaker recently addressed a group at the National Alliance on Mental Illness (NAMI) annual convention in San Antonio, Texas. So why was Whitaker invited to the national NAMI convention and how did it turn out?

Just as the American Psychiatric Association's (APA) long-delayed DSM5 was about to launch, the director of NIMH, Dr Thomas Insel, provoked a flurry of acrimony when he mentioned in his blog that his organisation intended to move away from the ideas behind DSM: “Patients with mental disorders deserve better... NIMH will be re-orienting its research away from DSM categories... we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system”. It now seems Insel's comments had more to do with NIMH funding needs than points of principle.

When we look closely at the current mainstream diagnostic and support system for so-called mental disorders today, the utter absurdity of it quickly becomes apparent. We have a system composed of literally hundreds of discrete “mental disorders” (those listed in the DSM), all of which are believed to be the direct result of soon to be discovered brain diseases, in spite of the fact no reliable biomarkers have yet been found for any of them after a century of intense searching, a fact acknowledged just last month by the current designer-in-chief of this system himself.

“What I’d really like to do is stop everything,” I say. The reality is that psychiatrists are not the experts when it comes to getting people off psychiatric drugs.

I live a slow paced life. I meditate every morning, refuse to get a smart phone (yet), and it takes me generous amounts of time to do things. This isn't because I am “stupid” or slow to get things. Sometimes I wonder how others get so much done each day - yet the quality and vibration of what I do is unique. It needs time. How does this relate with psychiatric drugs? Psych drugs are rooted in impatience, urgency, emergency.

Peer support pioneer and MindFreedom board president Celia Brown discusses what it means to be a 'survivor of psychiatry' and the importance of human connection, and human rights in mental healthcare.

Why all the fuss over DSM-5? Why did Robert Spitzer, the editor of DSM-III, begin to protest about the “secrecy” surrounding its production as early as 2007? Why did Allen Frances, editor of DSM-IV, begin in 2009 to challenge the American Psychiatric Association’s (APA) announced goal that when making DSM-5 “everything is on the table”? Why did he dispute the APA’s position that there had been enough progress in neuroscience to call for a “paradigm shift”, and why did Frances and others go on to protest repeatedly what they viewed as DSM-5’s “medicalization of normality?”

Less than six months ago I had the great fortune to start working with a small group of fellow producers who had spent a chunk of time traveling and shooting at various conferences. Interviews with notable figures in the movement. Survivor stories. A mixed bag of “Mad Media”. Immersing myself in the now 200+ hours of raw footage was like swimming in a sea of the subconscious. So I was swallowed whole by the white whale, consumed with the energy to put my still-developing abilities to the best use I could think of.

Open the Paradigm.

If you haven't been labeled mentally ill by the American Psychiatric Association, you have to ask yourself what's wrong. Perhaps you were ahead of the game: you knew not to reveal yourself to them, you knew how to avoid them, you found other social support, and if so, a big congratulations. If not, what's wrong? Why have you conformed?

The last four years I've been running Poetry for Personal Power, a stigma reduction campaign funded by SAMHSA. Poetry for Personal Power has been going to Missouri Universities and asking students what they do to get through hard times and we now have about 400 incredible videos on You-Tube, with youth wellness tools.

The Critical Psychiatry Network is concerned with the way the controversy over the publication of DSM-5 is being portrayed in the media and by some academic psychiatrists. The issues raised by the DSM are complex and require careful and studied consideration. There are two aspects in particular that concern us. These relate to the portrayal of the controversy as a guild dispute, and the polarisation of the debate as one of nurture versus nature.

Imagine being able to live harmoniously amongst others without fear. I cannot. Cannot imagine it even a little bit. What can be created for people in my camp? People who are sensitive and had so much trauma in childhood that life among others is highly stressful, scary and worrisome? I'm allowing myself sanctuary-time alone, quiet time, time to write… yet… will things ever be different? Will I ever find my niche in this world, where I feel safe and able, valued and worthwhile, loved, adored and comfortable? I have no idea.

As co-chair of the Diagnostic Summit Committee of the Society for Humanistic Psychology, I am pleased to announce that today we officially launch the Global Summit on Diagnostic Alternatives (DxSummit.org), an online platform for rethinking mental health. Our goal is to provide a place for a collegial and rigorous discussion of alternative ways to conceptualize and practice diagnosis. Today's launch is marked by the appearance of our first eight posts. These posts come from a variety of prominent people in the field, each offering a unique perspective on the current state of diagnosis and where we might take things as we move forward.

What makes the DSM so pernicious is that it is a cultural document whose influence transcends not only psychiatric practice but also the Western civilization from which it originates. Each revision of the DSM rescripts and reimagines how we make sense of our experiences, reinterprets what thoughts, feelings and behaviors are socially sanctioned, and ultimately what it means to be human.

When Thomas Szasz’s name comes up in debates over defining mental illness, it is fairly common to hear people say something along the lines of, “Well, he made some good points, but he was just too extreme.” Yet I am struck by how conversations about DSM-5, being released this month, make the crisp arguments Szasz consistently offered for 50 years just as timely as ever. I’d even go so far as to suggest that a large number of counselors, psychologists, social workers, and psychiatrists pretty much agree with the main tenets of Szasz’s argument, despite their ongoing disclaimers.

Psych meds can not only put weight on regardless of how you otherwise care for yourself, they also tend to make people feel gravely lethargic and vaguely sick all the time. I could not exercise as I had before. Could not. It doesn't matter how much mental health professionals try to tell us that if we just exercised we'd be okay in the face of neurotoxic drugs that cause weight gain, because the fact is the drugs impede that capacity. This is not widely appreciated or understood and people on psych meds are again traumatized and made to feel guilty for something that is truly outside of their control as long as they are taking these medications.

The decision by the National Institute of Mental Health to part company with the APA’s forthcoming DSM-5 should not be taken as evidence that biological psychiatry is entering a terminal decline. Far from it, as the Director of NIMH Thomas Insel’s blog of 29th April 2013 makes clear, the reason NIMH has opted for its own Research Diagnostic Criteria (RDoC) is because they believe psychiatric patients deserve something better.

For everyone who goes on psychiatric drugs, the reason comes back to power imbalances in their personal life. Women who's husbands “make all of the money” and have an unequal share of the power, kids who's parents have power over them—frequently people who have less money and security, therefore less platform for authority than those around them. Mental illness is not in fact an illness but an unequal division of power and sense of security in a social group.

While some people find their lives ruined by belief in imagined conspiracies that affect them personally - they may isolate from, or even attack, friends and family, and get diagnosed with psychosis - many other people believe in conspiracies on the basis of little evidence, yet have prominent places in society or even bodies like the US Senate. Yet it seems clear to me that the same dynamics are often involved in both.