Sorry, not convinced. There is no reason to expect that any “circuit level dysfunction” consistently and predictably creates DSM “disorders,” because the “disorders” themselves have been shown to be invalid, as they subjectively grouped together heterogeneous groupings based solely on external observations.
When you have to talk about “Excessive glutamate excitotoxicity,” you’re clearly not talking about a measurable cause, but only a correlative observation. Why does someone have “EGE?” How does it happen? What’s the mechanism? Do ALL people with a particular “diagnosis” have EGE? Do ALL people with EGE get a particular diagnosis? Again, the diagnoses are so totally subjective that such predictiveness is absolutely not conceivable. If we START with the EEGs and then find a consistent CAUSE of the EEG “abnormalities”, then we might have a new “diagnosis” like TCD. But to expect that to directly correlate with these subjective DSM categories is kind of laughable. I mean, I’m open to listening to your proof, but I am absolutely certain you don’t have it, even if you can name a bunch of researchers who agree with you.
Like anything else, the qEEG studies show correlations, not causation, and they associate very poorly with the DSM categories on a disorder-by-disorder basis. Maybe (MAYBE) thalamocortical dysrhythmia is an actual “disorder,” caused by something that somehow causes abnormal qEEG scores, but it still tells us nothing about what is really causing the problem, nor what anyone could possibly do to alter their qEEG wave patterns.
Most “mental illnesses” are caused by abusive or neglectful environments, poverty, and other stresses of daily life. No amount of genetic manipulation will chance people’s propensity to struggle with the meaning of their experience.
Therapy that does not involve challenging the client’s established viewpoints is not therapy at all. It doesn’t take a lot of skill to simply validate someone else’s reality. That’s only the most basic starting point for any real therapy. Making folks feel more comfortable continuing to live and believe exactly as they have doesn’t really help.
That is absolutely the case. Benzo withdrawal, especially cold turkey, is very similar to getting off alcohol. If you’ve been using for a long time, the withdrawals can literally kill you. It needs to be medically supervised ideally, otherwise titrated down VERY slowly. Stopping all at once can be deadly!
Not to be contrary, but the “serotonin theory” of depression was already discredited fully before Prozac came to market. I’m not sure how playing up “low serotonin” as a reason for depression does not qualify as “disformative advertising.” Perhaps you should re-read Lydia’s two pieces and reconsider?
Well said! Childhood trauma is not the “crisis,” childhood ABUSE AND NEGLECT is the crisis! We need to stop “treating” the victims and start intervening with the perpetrators to stop the traumatization from spreading!!!
Sorry. There have always been high IQ people. And some of them are wonderful, caring, empathetic human beings. And others are total assholes. There have always been low IQ people. And some of them are wonderful, caring, empathetic human beings. And others are total assholes. The idea that some kind of “High IQ elite” will somehow plan a better society with the help of polygenetics unfortunately smacks very strongly of Eugenics. It’s easy when people believe they are “elite” for them to commit crimes against those they feel are below them on the scale of whatever they feel they are “elite” at. I don’t trust the “high IQ elite” any more than I do a group of poor teenagers hanging around the inner city. Both could be totally fine and safe and even wonderful people. But both could also be gangs of thugs planning to do me harm. Trusting someone because they have a high IQ is naive in the extreme. There are plenty of brilliant criminals out there. Some of them run countries or businesses or national “professional” organizations. They may be smart, but they don’t care about you or me. That’s just human nature.
I agree, we should not assume that “elite” people with “high IQ” necessarily have anything but their own interests at heart. There is no necessary connection between IQ and empathy. In fact, I can easily see these gene probability predictors being used very much in a Brave New World kind of context, to eliminate the “weaker” genetics rather than helping people survive better.
Science is value neutral, but how science is used is NOT. History has clearly shown that any ability humans have to identify humans who are somehow “less than” the supposed ideal has always provided the opportunity for prejudice and discrimination. I don’t see why this should be any different.
It is known that stimulants cause psychotic symptoms, and not especially rarely. If I remember correctly, one study had it at 6.7 %. Hardly negligible. But does anyone ever even mention it?
Especially when there is literally no evidence that it helps them out in the long term. Kids are kids – why don’t we expect them to act like kids? Why don’t we adjust our expectations instead of trying to adjust their brains?
Exactly! It works fine, it’s just doing something that the rest of us don’t actually find helpful. But someone is benefitting from it and benefitting big time, and for them, it’s working great!
Though I don’t always find that doctors respond to data. Especially psychiatric doctors. It often takes some pretty assertive advocacy to get them to listen, and I’d say most people don’t necessarily have those skills or the high amount of courage needed to apply them against professional “resistance.”
It was actually disproven BEFORE Prozac even hit the market. It’s 100% a marketing scheme, and the psychiatric world did nothing to dissuade consumers from believing this known deception, and most of them supported it whole hog despite knowing it is false. One of the more disgusting episodes in human history!
We can’t define “overdiagnosis” or “misdiagnosis” when the diagnostic categories are so utterly subjective. We need to get away from “diagnostic language” altogether and treat these children as the unique individuals that they are.
There can be no positive change without a full acknowledgement and accounting of the harms done in the name of “mental health” today and in the past. I have been “in the system” and been attacked or ostracized for pointing out scientific realities that are inconvenient. I see some wishing that change would happen, but very few willing to confront that the entire edifice needs to be brought down in order to start over again with different assumptions. I don’t anticipate change from within. Too many have their snoots in the trough to accept the harsh reality that you and I see so clearly.
I’ve always regarded DBT as a set of techniques or skills, rather than a “therapy” in and of itself. Same with CBT. Therapists should be equipped with a wide range of techniques which they can apply when the situation warrants it, but anyone who is married to a particular “manualized therapy” is bound to do some damage to at least some clients. Humans are not machines, you can’t program them to act or feel “better.” We have to engage each person in, as you say, an individualized process that works for them. Very few therapists, in my experience, seem to be capable and/or interested in learning this much more organic and human approach to helping people.
I agree with you completely on all points. I think we are of one mind on these matters.
I can’t say I have any clue about the technological glitch you seem to have encountered. It shouldn’t work that way. I trust that you got posted what you needed to?
I don’t think child maltreatment is a “mental health problem”. I think it is a social problem, one of values and support and compassion. Those who abuse children aren’t ill, they are confused and emotionally unkind. Certainly their victims can’t be called ill, either, even though they often are labeled so for their understandable reactions to being abused. Most abusive parents have also been victimized by their own parents, and are generally repeating what they have been taught that parents are supposed to do. This is not an illness, it’s a problem of education and protection of children from harm.
I am not on the schizoid spectrum. I hated school from day one. I would have given anything to be allowed to escape. Why would someone need to be proven to be somehow “mentally unwell” to allow them to escape from such an oppressive, child-hating system?
I really can’t agree with you about the likelihood that any “mental illness” will be sufficiently predictable via “polygenetics” to be useful. The article you are posting on gives counterarguments. There’s another one posted recently that shows parental “mental illness” having little to no impact on the likelihood of a “schizophrenia” diagnosis, while childhood maltreatment has a strong impact.
Besides which, genes are the one thing we CAN’T change. Why not focus on making an environment that’s suitable for the varying types of humans, instead of trying to eliminate hundreds of variants from the gene pool, some of which may contribute to a lot of other traits besides a vulnerability to psychosis (if they even can predict that with any accuracy).
That was not the intent of my comment. Saying we are all just humans means to me that none of us are better than the others based on what we do for a living or any other reason. I am quite sure you agree with me.
Does it “complicate” the mainstream narrative? I rather think it invalidates it pretty thoroughly. it doesn’t seem that parental “mental health” has much if any impact on the development of psychosis later in life, but that childhood maltreatment has a LOT of impact. Isn’t that just the opposite of what we are being told by the mainstream “thought leaders?”
Of course, one could engage in an online education without being genotyped as “potentially schizophrenic.” Or we could just create more humane classrooms for ALL of the children forced to attend them. I agree that accepting others with different ways of being is central to a sane society. The error in thinking is that the bizarre, developmentally inappropriate expectations of our educational system are healthy for ANYONE who has to experience them.
Art may be more for the artist than the observer. I recently wrote a very emotional poem, not something I usually do. But it was quite cathartic for me. Others found it beautiful, but it didn’t have the same meaning for them. I wrote it for me more than anyone else.
Thank you. I have found peace in the wake of this sadness, with a very special new friend and some very good old ones. It comes and goes, but I feel like I’m doing about as well as could be hoped. This week is her birthday and also the anniversary of our first meeting (4th and 5th respectively) and it’s been a little rough. But I’m doing OK.
Absolutely. They go into withdrawals, which means they are MORE hyperactive than they were to start with often. But like I said, “professionals” often use this to convince parents that “see, when he stops using it, he gets so much worse!” without bothering to mention that they might get a whole lot BETTER once they actually got through the withdrawal period.
Or perhaps they ought to simply change the environment. Good research shows that so-called “ADHD” kids do way better in open classroom settings. Why aren’t we creating settings that work for these kids? Maybe they are a warning sign that the adults are not meeting the children’s need!!!
It may be worse to electrocute a developing brain than a fully developed one. But electrocution as a “treatment” for “mental illness” is rank insanity in any case! We generally do anything we can to avoid people having seizures. Why we’d want to induce one and imagine it is helpful is baffling beyond words!
Thank you, Kermit! It is an observable fact that we would not be here if not for you (and Bob, of course!) So right back at you – thanks for making MIA a functioning reality, and I am happy you will be rejoining us here on earth for a while longer!!!
I found this very touching, Kermit, after having dealt with my own brush with death and of course the loss of my wife. It is sometimes hard to remember the good fortune we have had in life, but love really IS the answer!!!
No, it doesn’t. It means stopping those with power (whatever color their skin) from taking over a culture and dictating what is supposed to be believed and acted upon. An example would be forcing other countries or cultures to adopt the DSM or ICD as a way of describing “mental illness” rather than using the ways they already have to describe such phenomena. The fact that white people have a lot of the power positions is merely a fact of life. Most white people are harmed by “colonization of mental health,” only a very small number have the power to actually create this effect, and they’re not all white, either.
This is a good reminder that AI is not actually “intelligent,” it does exactly and only what it is programmed to do. I’m sure that providing reassurance and common reality is a good thing in MOST conversations, but when AI starts agreeing with someone that killing themselves is understandable and helping them make a plan, we’ve gone way around the bend!
I do appreciate the honest response. I should have acknowledged you for both being willing to come here and for challenging standard practice yourself. I’ve been in the position of working with the system and I know it takes a lot courage to speak up and question the status quo.
Actually, I DO think we’d have a lot to talk about and if we were going to revise the system, you’d definitely be the kind of person I’d want to be planning it with.
And for the record, I don’t have any expectation that ALL psychiatrists act in any particular way. I had any number I used to work with who were open to feedback and a couple who worked with me and others on implementing a law to protect foster youth from over-drugging for behavioral reasons. My comments were mostly motivated by the seeming dismissal of the POSSIBILITY that there are, in fact, some in the field who DO engender ill intent or at best neglect, and that many of them have been quite powerful in influencing our cultural views of emotional and behavioral challenges without much respect for the actual science involved. I don’t think we make any progress without dealing with the “bad apples” in the barrel, especially if they are people with lots of influence in the field.
Looking forward to your next blog and thanks for being willing to engage with us despite having to face some pretty intense feedback!
I am NOT expressing contempt and condemnation. I am observing factual reality. It seems you are the one attempting to show contempt for the logic I have presented. For instance, you claim that “new drugs” means that doctors don’t know the information regarding withdrawal effects. I showed you that Prozac (marketed since 1987, almost 30 years ago) had been shown to have withdrawal effects as early as 1992. That is factual, not contemptuous or condemning. Yet your comment condemns me as “uncharitable” for not allowing psychiatry off the hook for this clear, observable and measurable failure.
Being reasonable and charitable can be helpful to a point, but we have to start with being honest with ourselves. It does not scan that psychiatrists didn’t notice for 20+ years that SSRIs had serious adverse effects. The only logical conclusions are that 1) they chose to ignore that information, or 2) they actively suppressed that information because it didn’t fit with their philosophical and/or economic model of reality. Making excuses for this failure does not lead to improving things for people in need. Honestly confronting the facts of inherent conflicts of interest and the actual PRACTICE of psychiatry in the field (vs. what you say the training is or should be) is essential to improving things for people in need. Nothing will change if we professionals make excuses for ourselves or blame clients for the behavior that our model has encouraged them to adopt. It’s a not a matter of contempt, it’s a matter of RESPONSIBILITY. Professionals are responsible for the results they obtain. If folks suffered adverse effects or withdrawal effects for decades and mainstream psychiatry failed to notice or intervene, the fault lies with the profession/system, not the clients/patients. I think that is a VERY reasonable proposal, that we start by relying on the actual known DATA rather than pursuing what is most economically or socially rewarding for the industry. No contempt, simply an insistence on holding ourselves responsible for our own results.
Patients’ resistance to stopping psych drugs has to be seen in context – if they have been told they will “relapse” and that their “brains are broken” and they have “diagnoses” that are vague but purportedly permanent, of course, they will be reluctant to reduce or stop drugs, ESPECIALLY when most have not been really given the opportunity to explore alternatives.
I used to work at a crisis line. Got a call one time from a person diagnosed with “major depression.” She was in a panic. She’d been trying different antidepressants for over a year, done 5 or more as I recall, and had no benefits. She felt like there was no hope, that she’d be depressed FOREVER!
I stopped her and asked, “Has anyone told you that there are other things you can do besides antidepressants for depression?” She paused for a moment. “No,” she said very calmly. “Well, there are,” I said. “Oh,” she said. “Well, THAT’S good!” And we talked about other options and she already felt a lot better. This discussion must happen, of course, BEFORE antidepressants are ever prescribed. It did not, and in my experience, if one sees a psychiatrist, it almost never does. If one thinks their only hope is antidepressants, of course, they will resist coming off of them. And yes, that IS blaming the clients!
Additionally, how do you know that the failure to discuss withdrawal problems was not done with malice or ignoring of information? Peter Breggin reported convincingly on antidepressant withdrawal, with good research references, way back in 1992. It is only in the last few years that withdrawal effects finally appear to be STARTING to be taken seriously. I still talk to plenty of people who are never informed of any possible withdrawal effects.
Again, it appears you are making excuses for professional failures. Are you suggesting that between 1987 and 2025 there hasn’t been PLENTY of time to research withdrawal effects, or that most psychiatrists ought to have been well aware of this problem (internet withdrawal groups have been around for decades)? Why is it so important to you that we “be reasonable” about the obvious failures of the profession? At what point do we stop assuming there is no ill intent and begin to face the fact that financial conflicts of interest have colored and distorted the psychiatric worldview so that drugs are, in fact, hugely favored without strong data supporting their efficacy?
Or to put it another less charitable way: It’s a lot easier to dehumanize clients who are involuntary and don’t have advocates there to stand up for them.
It seems you are willing to give other practitioners the benefit of a doubt in most cases. Years of experience disabused me of such notions. And the docs “not having other tools” is clearly a validation of my assertion that they only see biology as the cause. I’ve also had many a conversation with psychiatrists about these questions (I’m pretty assertive), and have gotten very bio-based responses. For instance, I talked to one guy (whom I actually liked quite a bit) about PTSD. He’d made it clear he thought biological brain differences were the main issue for psychiatrists to address. I asked him, “Well, in PTSD, there has to be a traumatic event to trigger the reaction. Doesn’t it seem like the traumatic event should be considered the primary cause?” His response was, “Not everyone gets PTSD from the same level of trauma. There MUST be something different in the brains of those who have that reaction.” See what I mean? No consideration of cultural context, of personality features, of social support networks or the lack thereof, of prior trauma, of resilience factors – no psychosocial analysis at all. Just, “They react differently. Brains must be different.” And this was one of the more educated and rational psychiatrists who was mostly in a research role, not overwhelmed by clients.
I do agree that lack of staff training in observing and intervening is a big issue. But isn’t that the psychiatrist’s job, to train them or make sure they have training? For example, the kid I mentioned with the extreme hand tremor was on four drugs, two antipsychotics and two mood stabilizers. All four had involuntary movements as potential side effects, and two specifically mention hand tremors in the product information. Yet the psychiatrist, when I told him we were concerned about side effects, said, “We haven’t noticed any side effects!” The hand tremors were obvious and the girl was spending a huge amount of energy trying to stop or disguise them, and she found it embarrassing that it was occurring to her. But the staff told her it was because she was “nervous”. The CASA spoke to the line staff, and they said they were NEVER told about potential side effects to watch out for when a kid started a new drug.
So at a certain point, we’re no longer talking about being overwhelmed. In the above case, we are talking about overt neglect and violation of the child’s right to informed consent (she was 14 and that right was posted on the “clients’ rights” posters all around the facility). Of course, once we convinced the psychiatrist to reduce the risperdal and lithium, the hand tremors decreased markedly. But they still told her it was nervousness, despite the clear scientific evidence it was not. This goes beyond being biologically oriented and moves into dehumanization of the client, as I mentioned above. No one should be treated that way, no matter how overwhelmed the staff is. Frankly, I think saying the doctors don’t have tools or enough time is pretty much an excuse. They ought to have other tools if they receive the training you assert is standard. It seems they are simply not applying them, and blaming the clients’ brains when their approach fails or creates other problems.
You also failed to address the overt claims that were frequently made to foster youth that despite massive trauma, they had “brain problems” that needed drugs to resolve. This is both a philosophical failure and further evidence of a lack of application of the supposed tools these psychiatrists were trained with. It doesn’t take a rocket scientist or a lot of extra time to recognize that the foster youth needs an acknowledgment that his/her distress is very real and is NOT the result of bad brain chemistry. It’s not an inability to do so that is the problem. It is either an unwillingness or a lack of empathy, and I truly believe and observe that the DSM diagnose-and-drug paradigm both allows for and increases the likelihood of such dismissive behavior on the part of ostensible professionals.
And I’ll end by saying that it’s not the client’s job to “be fair” or “understand the limitations” of their caretakers. Harm is harm, no matter why it happens. As an old friend of mine used to say, “It doesn’t matter why the milk truck doesn’t make it to the refrigeration center, the milk still spoils.” Clients who have been harmed, in particular, should not be expected to “be reasonable” about the professionals who failed them. We as professionals need to absorb their anger and critiques and reexamine our practices, not make excuses for bad service.
I appreciate you taking the time to write a considered response.
As to #3 and #4, it may not matter a lot what is taught, the choice to rely on “medications” as the first line and often ONLY intervention for “mental illnesses” makes any other non-medical-model considerations moot. I have known a large number of psychiatrists from my work in the child welfare system, and can count on one hand the number who actually prioritized non-drug analysis or interventions for foster youth, ALL of whom were certainly victims of childhood trauma of the most serious kind, both by their birth families and by the process of removing them to foster care. I’ve also spoken to dozens, maybe hundreds of foster youth, and have not met one yet who felt their problems or issues were mainly addressed by psychiatric diagnosis and “medication.” They were addressed by changing foster homes, by being adopted, by being empowered by attorneys or CASA volunteers to be their own advocates, by being particularly cared for by an excellent caseworker or social worker, according to the kids themselves. I’ve also encountered many kids being damaged by the “medical model” assumptions inherent in the label-and-drug process: kids becoming diabetic, becoming psychotic, relapsing into eating disordered behavior thanks to stimulants, becoming suicidal, having constant hand tremors and akathesia, among others. NONE of the situations I just mentioned were addressed by the MD psychiatrists whose drugs were creating the problems. ALL were resolved by advocacy by the CASA volunteer or by the child’s own decision to stop following the MD’s instructions.
So whatever the training, my experience is that in practice, most psychiatrists (at least the ones treating foster youth) are in fact quite committed to the “medical model,” but don’t even attempt to provide informed consent, let alone analysis of social factors contributing to the youth’s difficulties. Multiple foster youth have reported to me being told they were depressed “because you have a brain chemistry problem.” They were often incredulous, saying, “So they are telling me that my BRAIN is the problem, that if my BRAIN were working properly, despite being abused at home, removed from my family, moved to multiple foster homes, separated from my siblings, grandparents, relatives, forced to change schools multiple times… despite all of that, I’d NOT be depressed if my brain were working properly???!!”
It appears to me from my experience and the stories I hear that, notwithstanding the “bio-psycho-social model” claimed to be in use, most mainstream psychiatrists use the “bio-bio-bio” model and view ALL “mental illness” as problems with the brain. It is hard to see how any kind of change can happen in the field when the majority of practitioners fail to address or even consider the kind of psychosocial issues that are often behind or exacerbating the “symptoms” they are trying to suppress with their biological interventions.
And the only way to stop it is to stop taking that particular drug. The drug is the cause. I have never seen any kind of side effect “medication” be truly effective in stopping this, though such medications do exist.
I am familiar with Invega. It is an antipsychotic and most definitely could and often does cause akathesia and movement disorders.
You found the right way to respond. When there’s no button, just go back to the last one that HAS a respond button and use it, and your comment ends up at the end of the queue.
I have always thought we needed safe spaces for people to go to when they are feeling or acting out of control, but to unlink that from “diagnosis” and “treatment” unless that’s something the person wants or relates to. Folks can write “advance directives” for times they are unable to decide. But it’s certain we need safe spaces for people to destimulate from whatever is upsetting them. The idea that being held in such a place necessitates drug “treatment” is where I object to the process.
“This suggests a treatment culture that diverges from guideline recommendations, where symptom-targeted prescribing prevails despite the risks of side effects and overmedication”
Doesn’t this prescribe mainstream psychiatric practice? What are they doing other than “symptom-targeted prescribing?” Seems like the only tool they have in their “toolbox” for the most part.
You are a truth speaker. Those afraid of the truth will find you threatening and often be hostile toward you. I’ve found the same myself. I’m a perfectly kind and cooperative person in general, but I speak up when something is wrong. And some people (especially doctors) seem to have difficulty with this concept.
Quite so. It is a typical “blame the victim” scenario, and blaming fat people for being fat due to some character flaw is very much accepted in our culture.
I don’t either. Knowingly creating harm through fraudulent representations and blaming of the victim. Particularly egregious when the clients are young and involuntary, not in a position to defend themselves or often even understand they are under assault.
I worked with kids in foster care taking Zyprexa or other fat-inducing antipsychotics, and saw psychiatrists frequently put them on diets and exercise regimes, never telling them that their weight gain was caused or exacerbated by the drugs. I saw one case where a kid in recovery from an eating disorder was given stimulants. When she stopped eating, they treated her like her ‘eating disorder’ came back, rather than recognizing (as my CASA volunteer observed and informed them) that her loss of appetite was due to the foolish decision to give her stimulants! Another kid became psychotic on stimulants (which happens in close to 7% of the cases, per a Canadian J Psychiatry study), yet she was given a psychotic disorder NOS diagnosis and prescribed antipsychotics. She only stopped being psychotic after SHE decided to stop all the drugs! Another got diagnosed with diabetes, which disappeared when she stopped taking Seroquel at the CASA volunteer’s behest.
The ability and willingness to ignore the obvious connections between drug administration and behavioral/physiological adverse reactions seems endemic to psychiatry. If the person gets better, it’s always attributed to the drugs, but if they get worse, it’s “the disease” rearing its ugly head, even if the drugs are the obvious cause.
There is a difference in my mind between “authoritative” (able to take charge as needed and help keep things in order) vs. “authoritarian,” which to me means attached to power and willing to use it to keep “subordinates” in their place in the hierarchy. Doctors who believe patients should just “do as they are told” are the ones I think are most dangerous. I don’t mind my doctor having a strong opinion and expressing it, but I have the right to do the same, and if s/he can’t acknowledge that, s/he will quickly become my former doctor!
I don’t know how many, but it’s not a trivial number. And of course many should never have been approved in the first place but are still in use today. That’s why truly informed consent matters so much these days. Even the doctors don’t seem to know all the adverse effects that are acknowledged, and of course the drug companies only publish the ones they are forced to by the FDA. We are really on our own when it comes to protecting ourselves against dangerous drugs, but most people don’t realize that until something bad happens, and sometimes it’s too late!
I still think medical doctors need to be much more flexible and honest about side effects and options and alternatives. They also often exercise the option to be defensive when getting something wrong. Remember that most stimulants and antidepressants are prescribed by non-psychiatric doctors.
Plus my experience with cancer treatment tells me that most doctors don’t really know about the drugs they prescribe. I recently experienced a sudden and dramatic recovery from significant anemia after discontinuing one blood pressure drug (Losartan) at my own behest. Sure enough, looking up that drug immediately showed red blood cell production to be suppressed in rare cases, but particularly if one is over 60 (which I am) and takes it for an extended period (which I had been). When I confronted the doctor about it, he said, “I’ve never seen that.” Well, now he has. But he didn’t even record the dramatic recovery in the chart notes. Just said I’d potentially lost some kind of protection against sudden heart attacks, “But I did not take up this issue with the patient.”
Doctors should advise. Patients should decide. Doctors should be honest and accept patient feedback. Even if they are “right,” authoritarian doctors prevent feedback and disempower clients. And empowered clients have better outcomes.
Yeah, remember Vioxx? Caused strokes and heart disease, literally killed people, but the drug company buried the data until they’d made billions of dollars on this blockbuster drug. No one went to prison for this, either. Not even sure they were fined. It’s not a rare thing.
It is true that many are driven to become therapists by a feeling of their own incompleteness or inadequacy. This in itself should not disqualify them, but they must have already dealt with these feelings effectively themselves and be relatively emotionally healthy in order NOT to take advantage of the noted power imbalance. I have found such people rare, either in or out of the therapeutic professions. Among psychiatrists, I’ve found them almost nonexistent. Doctors in general tend toward the authoritarian, I’d say, but the number of truly self-aware and non-authoritarian psychiatrists I’ve met over many years of working both within and on the edges of the system can be counted on one hand.
The CLIENT should be the one who “balances the risks with the benefits.” Too many doctors, and especially psychiatrists, seem to think THEY get to make this assessment. It’s their job to outline the risks and benefits for the client. The client then gets to decide what the balance is. This is too often forgotten!
Thank you, Rosalee. It has been quite a process so far, and still only 4 months in. But I have learned a lot about myself and finding my way. It’s a big change!
Niko, I previously sent you an email about your prior comment explaining why I could not publish it. Please check your emails and respond via email so we can resolve the issues.
Ah, but I DID often confide in my clients. I found self-disclosure to be a very powerful way to connect on a real level, even if there are some who would have criticized my “poor boundaries.” But I get where you’re coming from. I’ve always been a big fan of support groups NOT “facilitated by a professional.” Those who have been there and done that are usually the safest people to talk and share with. And again, finding a capable therapist is a challenging proposition. I was quite aggressive in my screening and prepared to drop the grief counselor at a moment’s notice if the process did not meet my needs. Most potential clients are not in a position to take such an assertive stance, nor are most aware that they need to. Only years of experiencing seeing how crappy the average therapy experience was led me to be able to take such steps. I certainly would never trust or assume that the therapist in question was competent or safe without thoroughly testing them out in ways that most people would not realize are necessary or have the skills to accomplish.
I have had the same experience. It is next to impossible to find a doctor who truly supports withdrawal. Some will “allow” it but generally convey suspicion and condescension toward clients attempting this kind of effort. And if things deteriorate, most are very quickly told, “See, there is proof that you are relapsing and you need the ‘medication.'”
I think we’re all irrational to some degree. Which is why it’s silly to call some people “mentally ill” because they act in certain ways, since almost anyone could be so labeled in the right (or wrong) circumstances. I am sure I could get such a label slapped on me since my wife died, if I let anyone with the power close enough to do so. And yes, I do behave irrationally sometimes. It’s part of being human.
It is true that help of any sort is hampered by power dynamics, not just in therapy, of course, but with doctors, teachers, lawyers, social workers, and so on. Some people choose to take advantage of their one-up power situation, some don’t. To be useful, therapists would have to be trusted to step down from their one-up position. But of course, no one can guarantee that, which makes seeking a therapist fraught with potential harm. As I’ve said many times, the fact of being a therapist or having a degree is no guarantee of being helpful. It doesn’t even improve the odds.
However, I have seen some remarkable work done by therapists from time to time. I can’t dismiss it altogether as always being a bad thing, since I benefitted from a good therapist myself. But that was my good fortune. It was also back in the 80s, when therapists had not yet been trained to be DSM-compliant as most have today. I have, in fact, recently found a grief counselor who has been very helpful to me, and I appreciate her. But believe you me, I screened heavily before engaging with her, and told her what I expected and that I would only continue if those expectations were met. She wasn’t perfect (who is), but she accepted and acted on my feedback, and did provide some excellent support when I needed it. So have any number of friends I have relied on since the loss of my wife, including a local pastor with whom I am now good friends. Help comes from wherever it comes from, and just because power dynamics can be exercised by a provider doesn’t mean they will. It’s not quite that black and white to me.
I agree wholeheartedly with your proposed approach. Boundaries means saying “no” politely but firmly, not humiliating the client! And you are also correct to say that the power imbalance makes it too easy to be defensive and take out feelings on the client. It’s up to the therapist not to abuse the power imbalance, but I find few who really are capable of doing so.
I absolutely support that he has the right to ask her not to record the sessions, and refusing the gift was the right thing to do. What I’m trying to say is that her decision to do so says something about HER and what her ideas, needs and motivations are. One can set expectations without engaging in power dynamics. Whatever the client does, whether it’s allowed to continue or not, provides an opportunity to understand her motivations and intentions and provides a pathway to understanding what is behind them. Which is, after all, what therapy is supposed to be about. Again, let’s say she’s agreed to a no-recording policy. The conversation can easily go to, “Do you remember signing the agreement not to record the sessions? So if you knew that, what made you feel that recording them was necessary?” Or words to that effect. Something is going on with her. You don’t have to allow her to keep recording sessions without humiliating her or making her feel small. After all, she IS the client – if she were entirely rational, why would she be needing therapy? Why not use the opportunity to explore what is underneath her behavior, rather than shaming her? That’s what I’m suggesting.
“Boundaries” can be used as tools or weapons by the person with more power, hence the therapists. It can be a way to avoid the therapist’s own feelings and blame the client. That seems to me like what happened to the author.
You are laboring under the illusion that those training therapists are doing so in accordance with what science shows to be most essential!
I’m also not too sure such training can be effective with just anyone. I think it requires a good bit of self-awareness that would require the therapist to deal with his/her own issues before assuming such a role. A lot of people are not interested in or are not capable of that level of self-awareness, and as such should probably be disallowed from ever becoming therapists. But of course, that assumes the TRAINERS and LICENSERS have that degree of self-awareness as well…
Bottom line, it’s kind of a long shot to find someone who really knows how to help. And I don’t know how to screen them except for personal experience. It’s a conundrum, especially when folks are often getting paid for providing little or for making things worse!
I don’t agree. Catherine is not responsible to gain Eugene’s trust. It’s the other way around. If she were recording me, I’d be saying, “That’s an interesting decision you made there. Why did you think it was important to record our conversations?” It would not be at all threatening – just another opportunity to develop the relationship with the client.
Because when comparing results of different “styles” or “schools” of therapy, none of them were consistently superior. The ONLY variable that consistently predicted better outcomes was the quality of relationship with the therapist. If people felt safe and heard and believed, they did better. If they saw the therapist as aloof or distant or dismissive or invalidative, they did worse. It is kind of that simple.
Of course, as we have said multiple times before, therapists are not especially more likely than the general public to have these skills. Science has supported that, too. You’re just as likely to feel helped by a friend or neighbor or colleague as a therapist. It all comes down to good listening and being there for the person, wherever they are at. IMHO.
That is just awful! Criminal, really. They know this can happen but don’t even bother telling their patients or their relatives/carers that it’s possible, and then when it happens, they blame the patient or “his disease!” I’m so, so sorry you have had to deal with this. I agree, fines are not sufficient. Jail time is appropriate!
It is extremely disingenuous for psychiatrists to blame patients’ misconceptions about drugs and “diagnoses” on the pharmaceutical industry. They’ve been foursquare walking together the entire time since the DSM III in 1980. As for Risperdal, the “off-label” use of these drugs is rampant, for kids, the elderly, and even as an (PLEASE!) adjunct for “antidepressants!” Off label use is legal but needs to be reined in, as far as I’m concerned. It’s dangerous!
You sound like “one of the good ones,” Hoda. You are right, it’s all about the relationship. Science has shown that to be the case, yet we continue to train people to “have boundaries” by denying the basic humanity of one person communicating honestly with another. Techniques can be handy, but truly caring and being deeply curious about the client are essential for any kind of success. Plus being humble and flexible, to do what works FOR THIS CLIENT instead of what someone says you’re supposed to do!
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OK, I’m stopping this conversation. It’s off topic and unproductive.
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Sorry, not convinced. There is no reason to expect that any “circuit level dysfunction” consistently and predictably creates DSM “disorders,” because the “disorders” themselves have been shown to be invalid, as they subjectively grouped together heterogeneous groupings based solely on external observations.
When you have to talk about “Excessive glutamate excitotoxicity,” you’re clearly not talking about a measurable cause, but only a correlative observation. Why does someone have “EGE?” How does it happen? What’s the mechanism? Do ALL people with a particular “diagnosis” have EGE? Do ALL people with EGE get a particular diagnosis? Again, the diagnoses are so totally subjective that such predictiveness is absolutely not conceivable. If we START with the EEGs and then find a consistent CAUSE of the EEG “abnormalities”, then we might have a new “diagnosis” like TCD. But to expect that to directly correlate with these subjective DSM categories is kind of laughable. I mean, I’m open to listening to your proof, but I am absolutely certain you don’t have it, even if you can name a bunch of researchers who agree with you.
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Like anything else, the qEEG studies show correlations, not causation, and they associate very poorly with the DSM categories on a disorder-by-disorder basis. Maybe (MAYBE) thalamocortical dysrhythmia is an actual “disorder,” caused by something that somehow causes abnormal qEEG scores, but it still tells us nothing about what is really causing the problem, nor what anyone could possibly do to alter their qEEG wave patterns.
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Most “mental illnesses” are caused by abusive or neglectful environments, poverty, and other stresses of daily life. No amount of genetic manipulation will chance people’s propensity to struggle with the meaning of their experience.
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Therapy that does not involve challenging the client’s established viewpoints is not therapy at all. It doesn’t take a lot of skill to simply validate someone else’s reality. That’s only the most basic starting point for any real therapy. Making folks feel more comfortable continuing to live and believe exactly as they have doesn’t really help.
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That is absolutely the case. Benzo withdrawal, especially cold turkey, is very similar to getting off alcohol. If you’ve been using for a long time, the withdrawals can literally kill you. It needs to be medically supervised ideally, otherwise titrated down VERY slowly. Stopping all at once can be deadly!
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As soon as it becomes acceptable to look on someone as “less than,” humans will start abusing them. It’s 100% inevitable.
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Hey, you are as qualified as anyone to do it! Why not be an entrepreneur?
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Wow, I feel SO much better now!
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On the other hand, maybe the reason you don’t comprehend them is because they don’t actually make sense!
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Tell me more about “AI Hallucinations,” Bill. I find that idea fascinating!
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Not to be contrary, but the “serotonin theory” of depression was already discredited fully before Prozac came to market. I’m not sure how playing up “low serotonin” as a reason for depression does not qualify as “disformative advertising.” Perhaps you should re-read Lydia’s two pieces and reconsider?
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Well said! Childhood trauma is not the “crisis,” childhood ABUSE AND NEGLECT is the crisis! We need to stop “treating” the victims and start intervening with the perpetrators to stop the traumatization from spreading!!!
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Sorry. There have always been high IQ people. And some of them are wonderful, caring, empathetic human beings. And others are total assholes. There have always been low IQ people. And some of them are wonderful, caring, empathetic human beings. And others are total assholes. The idea that some kind of “High IQ elite” will somehow plan a better society with the help of polygenetics unfortunately smacks very strongly of Eugenics. It’s easy when people believe they are “elite” for them to commit crimes against those they feel are below them on the scale of whatever they feel they are “elite” at. I don’t trust the “high IQ elite” any more than I do a group of poor teenagers hanging around the inner city. Both could be totally fine and safe and even wonderful people. But both could also be gangs of thugs planning to do me harm. Trusting someone because they have a high IQ is naive in the extreme. There are plenty of brilliant criminals out there. Some of them run countries or businesses or national “professional” organizations. They may be smart, but they don’t care about you or me. That’s just human nature.
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I agree, we should not assume that “elite” people with “high IQ” necessarily have anything but their own interests at heart. There is no necessary connection between IQ and empathy. In fact, I can easily see these gene probability predictors being used very much in a Brave New World kind of context, to eliminate the “weaker” genetics rather than helping people survive better.
Science is value neutral, but how science is used is NOT. History has clearly shown that any ability humans have to identify humans who are somehow “less than” the supposed ideal has always provided the opportunity for prejudice and discrimination. I don’t see why this should be any different.
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It is known that stimulants cause psychotic symptoms, and not especially rarely. If I remember correctly, one study had it at 6.7 %. Hardly negligible. But does anyone ever even mention it?
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If you took the attitude you did about it. I’d say most doctors would not.
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Especially when there is literally no evidence that it helps them out in the long term. Kids are kids – why don’t we expect them to act like kids? Why don’t we adjust our expectations instead of trying to adjust their brains?
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Exactly! It works fine, it’s just doing something that the rest of us don’t actually find helpful. But someone is benefitting from it and benefitting big time, and for them, it’s working great!
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Though I don’t always find that doctors respond to data. Especially psychiatric doctors. It often takes some pretty assertive advocacy to get them to listen, and I’d say most people don’t necessarily have those skills or the high amount of courage needed to apply them against professional “resistance.”
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It was actually disproven BEFORE Prozac even hit the market. It’s 100% a marketing scheme, and the psychiatric world did nothing to dissuade consumers from believing this known deception, and most of them supported it whole hog despite knowing it is false. One of the more disgusting episodes in human history!
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I agree with you and appreciate the feedback!
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Thanks for the update. I’m glad you got it sorted!
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We can’t define “overdiagnosis” or “misdiagnosis” when the diagnostic categories are so utterly subjective. We need to get away from “diagnostic language” altogether and treat these children as the unique individuals that they are.
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It’s Russian Roulette, but with 5 loaded chambers instead of just one. Not many “winners!”
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There can be no positive change without a full acknowledgement and accounting of the harms done in the name of “mental health” today and in the past. I have been “in the system” and been attacked or ostracized for pointing out scientific realities that are inconvenient. I see some wishing that change would happen, but very few willing to confront that the entire edifice needs to be brought down in order to start over again with different assumptions. I don’t anticipate change from within. Too many have their snoots in the trough to accept the harsh reality that you and I see so clearly.
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Wow, that is downright poetic! Thank you, Mario!
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I’ve always regarded DBT as a set of techniques or skills, rather than a “therapy” in and of itself. Same with CBT. Therapists should be equipped with a wide range of techniques which they can apply when the situation warrants it, but anyone who is married to a particular “manualized therapy” is bound to do some damage to at least some clients. Humans are not machines, you can’t program them to act or feel “better.” We have to engage each person in, as you say, an individualized process that works for them. Very few therapists, in my experience, seem to be capable and/or interested in learning this much more organic and human approach to helping people.
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I agree with you completely on all points. I think we are of one mind on these matters.
I can’t say I have any clue about the technological glitch you seem to have encountered. It shouldn’t work that way. I trust that you got posted what you needed to?
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I don’t think child maltreatment is a “mental health problem”. I think it is a social problem, one of values and support and compassion. Those who abuse children aren’t ill, they are confused and emotionally unkind. Certainly their victims can’t be called ill, either, even though they often are labeled so for their understandable reactions to being abused. Most abusive parents have also been victimized by their own parents, and are generally repeating what they have been taught that parents are supposed to do. This is not an illness, it’s a problem of education and protection of children from harm.
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I am not on the schizoid spectrum. I hated school from day one. I would have given anything to be allowed to escape. Why would someone need to be proven to be somehow “mentally unwell” to allow them to escape from such an oppressive, child-hating system?
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I really can’t agree with you about the likelihood that any “mental illness” will be sufficiently predictable via “polygenetics” to be useful. The article you are posting on gives counterarguments. There’s another one posted recently that shows parental “mental illness” having little to no impact on the likelihood of a “schizophrenia” diagnosis, while childhood maltreatment has a strong impact.
Besides which, genes are the one thing we CAN’T change. Why not focus on making an environment that’s suitable for the varying types of humans, instead of trying to eliminate hundreds of variants from the gene pool, some of which may contribute to a lot of other traits besides a vulnerability to psychosis (if they even can predict that with any accuracy).
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That was not the intent of my comment. Saying we are all just humans means to me that none of us are better than the others based on what we do for a living or any other reason. I am quite sure you agree with me.
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Does it “complicate” the mainstream narrative? I rather think it invalidates it pretty thoroughly. it doesn’t seem that parental “mental health” has much if any impact on the development of psychosis later in life, but that childhood maltreatment has a LOT of impact. Isn’t that just the opposite of what we are being told by the mainstream “thought leaders?”
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Of course, one could engage in an online education without being genotyped as “potentially schizophrenic.” Or we could just create more humane classrooms for ALL of the children forced to attend them. I agree that accepting others with different ways of being is central to a sane society. The error in thinking is that the bizarre, developmentally inappropriate expectations of our educational system are healthy for ANYONE who has to experience them.
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Well, I certainly meant that no one should hold themselves above another because of their identity or role in life. Maybe you should read it again?
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I think I just said that.
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I suppose any time folks think that being in a particular category makes them more worthwhile than others, we have problems. We’re all just humans!
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Art may be more for the artist than the observer. I recently wrote a very emotional poem, not something I usually do. But it was quite cathartic for me. Others found it beautiful, but it didn’t have the same meaning for them. I wrote it for me more than anyone else.
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Thank you. I have found peace in the wake of this sadness, with a very special new friend and some very good old ones. It comes and goes, but I feel like I’m doing about as well as could be hoped. This week is her birthday and also the anniversary of our first meeting (4th and 5th respectively) and it’s been a little rough. But I’m doing OK.
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Absolutely. They go into withdrawals, which means they are MORE hyperactive than they were to start with often. But like I said, “professionals” often use this to convince parents that “see, when he stops using it, he gets so much worse!” without bothering to mention that they might get a whole lot BETTER once they actually got through the withdrawal period.
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Or perhaps they ought to simply change the environment. Good research shows that so-called “ADHD” kids do way better in open classroom settings. Why aren’t we creating settings that work for these kids? Maybe they are a warning sign that the adults are not meeting the children’s need!!!
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Both lovely songs, Richard! Thanks for sharing them – it’s given me a good start to my day!
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Often the selection criteria create a situation where no real information can be gained from the research, because the group is heterogeneous.
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It may be worse to electrocute a developing brain than a fully developed one. But electrocution as a “treatment” for “mental illness” is rank insanity in any case! We generally do anything we can to avoid people having seizures. Why we’d want to induce one and imagine it is helpful is baffling beyond words!
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Thank you, Kermit! It is an observable fact that we would not be here if not for you (and Bob, of course!) So right back at you – thanks for making MIA a functioning reality, and I am happy you will be rejoining us here on earth for a while longer!!!
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Thank you!
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I found this very touching, Kermit, after having dealt with my own brush with death and of course the loss of my wife. It is sometimes hard to remember the good fortune we have had in life, but love really IS the answer!!!
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No, it doesn’t. It means stopping those with power (whatever color their skin) from taking over a culture and dictating what is supposed to be believed and acted upon. An example would be forcing other countries or cultures to adopt the DSM or ICD as a way of describing “mental illness” rather than using the ways they already have to describe such phenomena. The fact that white people have a lot of the power positions is merely a fact of life. Most white people are harmed by “colonization of mental health,” only a very small number have the power to actually create this effect, and they’re not all white, either.
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Wow. That sounds pretty mechanical!
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This is a good reminder that AI is not actually “intelligent,” it does exactly and only what it is programmed to do. I’m sure that providing reassurance and common reality is a good thing in MOST conversations, but when AI starts agreeing with someone that killing themselves is understandable and helping them make a plan, we’ve gone way around the bend!
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I do appreciate the honest response. I should have acknowledged you for both being willing to come here and for challenging standard practice yourself. I’ve been in the position of working with the system and I know it takes a lot courage to speak up and question the status quo.
Actually, I DO think we’d have a lot to talk about and if we were going to revise the system, you’d definitely be the kind of person I’d want to be planning it with.
And for the record, I don’t have any expectation that ALL psychiatrists act in any particular way. I had any number I used to work with who were open to feedback and a couple who worked with me and others on implementing a law to protect foster youth from over-drugging for behavioral reasons. My comments were mostly motivated by the seeming dismissal of the POSSIBILITY that there are, in fact, some in the field who DO engender ill intent or at best neglect, and that many of them have been quite powerful in influencing our cultural views of emotional and behavioral challenges without much respect for the actual science involved. I don’t think we make any progress without dealing with the “bad apples” in the barrel, especially if they are people with lots of influence in the field.
Looking forward to your next blog and thanks for being willing to engage with us despite having to face some pretty intense feedback!
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I am NOT expressing contempt and condemnation. I am observing factual reality. It seems you are the one attempting to show contempt for the logic I have presented. For instance, you claim that “new drugs” means that doctors don’t know the information regarding withdrawal effects. I showed you that Prozac (marketed since 1987, almost 30 years ago) had been shown to have withdrawal effects as early as 1992. That is factual, not contemptuous or condemning. Yet your comment condemns me as “uncharitable” for not allowing psychiatry off the hook for this clear, observable and measurable failure.
Being reasonable and charitable can be helpful to a point, but we have to start with being honest with ourselves. It does not scan that psychiatrists didn’t notice for 20+ years that SSRIs had serious adverse effects. The only logical conclusions are that 1) they chose to ignore that information, or 2) they actively suppressed that information because it didn’t fit with their philosophical and/or economic model of reality. Making excuses for this failure does not lead to improving things for people in need. Honestly confronting the facts of inherent conflicts of interest and the actual PRACTICE of psychiatry in the field (vs. what you say the training is or should be) is essential to improving things for people in need. Nothing will change if we professionals make excuses for ourselves or blame clients for the behavior that our model has encouraged them to adopt. It’s a not a matter of contempt, it’s a matter of RESPONSIBILITY. Professionals are responsible for the results they obtain. If folks suffered adverse effects or withdrawal effects for decades and mainstream psychiatry failed to notice or intervene, the fault lies with the profession/system, not the clients/patients. I think that is a VERY reasonable proposal, that we start by relying on the actual known DATA rather than pursuing what is most economically or socially rewarding for the industry. No contempt, simply an insistence on holding ourselves responsible for our own results.
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Patients’ resistance to stopping psych drugs has to be seen in context – if they have been told they will “relapse” and that their “brains are broken” and they have “diagnoses” that are vague but purportedly permanent, of course, they will be reluctant to reduce or stop drugs, ESPECIALLY when most have not been really given the opportunity to explore alternatives.
I used to work at a crisis line. Got a call one time from a person diagnosed with “major depression.” She was in a panic. She’d been trying different antidepressants for over a year, done 5 or more as I recall, and had no benefits. She felt like there was no hope, that she’d be depressed FOREVER!
I stopped her and asked, “Has anyone told you that there are other things you can do besides antidepressants for depression?” She paused for a moment. “No,” she said very calmly. “Well, there are,” I said. “Oh,” she said. “Well, THAT’S good!” And we talked about other options and she already felt a lot better. This discussion must happen, of course, BEFORE antidepressants are ever prescribed. It did not, and in my experience, if one sees a psychiatrist, it almost never does. If one thinks their only hope is antidepressants, of course, they will resist coming off of them. And yes, that IS blaming the clients!
Additionally, how do you know that the failure to discuss withdrawal problems was not done with malice or ignoring of information? Peter Breggin reported convincingly on antidepressant withdrawal, with good research references, way back in 1992. It is only in the last few years that withdrawal effects finally appear to be STARTING to be taken seriously. I still talk to plenty of people who are never informed of any possible withdrawal effects.
Again, it appears you are making excuses for professional failures. Are you suggesting that between 1987 and 2025 there hasn’t been PLENTY of time to research withdrawal effects, or that most psychiatrists ought to have been well aware of this problem (internet withdrawal groups have been around for decades)? Why is it so important to you that we “be reasonable” about the obvious failures of the profession? At what point do we stop assuming there is no ill intent and begin to face the fact that financial conflicts of interest have colored and distorted the psychiatric worldview so that drugs are, in fact, hugely favored without strong data supporting their efficacy?
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Very well said!
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Or to put it another less charitable way: It’s a lot easier to dehumanize clients who are involuntary and don’t have advocates there to stand up for them.
It seems you are willing to give other practitioners the benefit of a doubt in most cases. Years of experience disabused me of such notions. And the docs “not having other tools” is clearly a validation of my assertion that they only see biology as the cause. I’ve also had many a conversation with psychiatrists about these questions (I’m pretty assertive), and have gotten very bio-based responses. For instance, I talked to one guy (whom I actually liked quite a bit) about PTSD. He’d made it clear he thought biological brain differences were the main issue for psychiatrists to address. I asked him, “Well, in PTSD, there has to be a traumatic event to trigger the reaction. Doesn’t it seem like the traumatic event should be considered the primary cause?” His response was, “Not everyone gets PTSD from the same level of trauma. There MUST be something different in the brains of those who have that reaction.” See what I mean? No consideration of cultural context, of personality features, of social support networks or the lack thereof, of prior trauma, of resilience factors – no psychosocial analysis at all. Just, “They react differently. Brains must be different.” And this was one of the more educated and rational psychiatrists who was mostly in a research role, not overwhelmed by clients.
I do agree that lack of staff training in observing and intervening is a big issue. But isn’t that the psychiatrist’s job, to train them or make sure they have training? For example, the kid I mentioned with the extreme hand tremor was on four drugs, two antipsychotics and two mood stabilizers. All four had involuntary movements as potential side effects, and two specifically mention hand tremors in the product information. Yet the psychiatrist, when I told him we were concerned about side effects, said, “We haven’t noticed any side effects!” The hand tremors were obvious and the girl was spending a huge amount of energy trying to stop or disguise them, and she found it embarrassing that it was occurring to her. But the staff told her it was because she was “nervous”. The CASA spoke to the line staff, and they said they were NEVER told about potential side effects to watch out for when a kid started a new drug.
So at a certain point, we’re no longer talking about being overwhelmed. In the above case, we are talking about overt neglect and violation of the child’s right to informed consent (she was 14 and that right was posted on the “clients’ rights” posters all around the facility). Of course, once we convinced the psychiatrist to reduce the risperdal and lithium, the hand tremors decreased markedly. But they still told her it was nervousness, despite the clear scientific evidence it was not. This goes beyond being biologically oriented and moves into dehumanization of the client, as I mentioned above. No one should be treated that way, no matter how overwhelmed the staff is. Frankly, I think saying the doctors don’t have tools or enough time is pretty much an excuse. They ought to have other tools if they receive the training you assert is standard. It seems they are simply not applying them, and blaming the clients’ brains when their approach fails or creates other problems.
You also failed to address the overt claims that were frequently made to foster youth that despite massive trauma, they had “brain problems” that needed drugs to resolve. This is both a philosophical failure and further evidence of a lack of application of the supposed tools these psychiatrists were trained with. It doesn’t take a rocket scientist or a lot of extra time to recognize that the foster youth needs an acknowledgment that his/her distress is very real and is NOT the result of bad brain chemistry. It’s not an inability to do so that is the problem. It is either an unwillingness or a lack of empathy, and I truly believe and observe that the DSM diagnose-and-drug paradigm both allows for and increases the likelihood of such dismissive behavior on the part of ostensible professionals.
And I’ll end by saying that it’s not the client’s job to “be fair” or “understand the limitations” of their caretakers. Harm is harm, no matter why it happens. As an old friend of mine used to say, “It doesn’t matter why the milk truck doesn’t make it to the refrigeration center, the milk still spoils.” Clients who have been harmed, in particular, should not be expected to “be reasonable” about the professionals who failed them. We as professionals need to absorb their anger and critiques and reexamine our practices, not make excuses for bad service.
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Richard,
I appreciate you taking the time to write a considered response.
As to #3 and #4, it may not matter a lot what is taught, the choice to rely on “medications” as the first line and often ONLY intervention for “mental illnesses” makes any other non-medical-model considerations moot. I have known a large number of psychiatrists from my work in the child welfare system, and can count on one hand the number who actually prioritized non-drug analysis or interventions for foster youth, ALL of whom were certainly victims of childhood trauma of the most serious kind, both by their birth families and by the process of removing them to foster care. I’ve also spoken to dozens, maybe hundreds of foster youth, and have not met one yet who felt their problems or issues were mainly addressed by psychiatric diagnosis and “medication.” They were addressed by changing foster homes, by being adopted, by being empowered by attorneys or CASA volunteers to be their own advocates, by being particularly cared for by an excellent caseworker or social worker, according to the kids themselves. I’ve also encountered many kids being damaged by the “medical model” assumptions inherent in the label-and-drug process: kids becoming diabetic, becoming psychotic, relapsing into eating disordered behavior thanks to stimulants, becoming suicidal, having constant hand tremors and akathesia, among others. NONE of the situations I just mentioned were addressed by the MD psychiatrists whose drugs were creating the problems. ALL were resolved by advocacy by the CASA volunteer or by the child’s own decision to stop following the MD’s instructions.
So whatever the training, my experience is that in practice, most psychiatrists (at least the ones treating foster youth) are in fact quite committed to the “medical model,” but don’t even attempt to provide informed consent, let alone analysis of social factors contributing to the youth’s difficulties. Multiple foster youth have reported to me being told they were depressed “because you have a brain chemistry problem.” They were often incredulous, saying, “So they are telling me that my BRAIN is the problem, that if my BRAIN were working properly, despite being abused at home, removed from my family, moved to multiple foster homes, separated from my siblings, grandparents, relatives, forced to change schools multiple times… despite all of that, I’d NOT be depressed if my brain were working properly???!!”
It appears to me from my experience and the stories I hear that, notwithstanding the “bio-psycho-social model” claimed to be in use, most mainstream psychiatrists use the “bio-bio-bio” model and view ALL “mental illness” as problems with the brain. It is hard to see how any kind of change can happen in the field when the majority of practitioners fail to address or even consider the kind of psychosocial issues that are often behind or exacerbating the “symptoms” they are trying to suppress with their biological interventions.
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“Treatment resistant” is code for “I don’t know what the f*&k I’m doing!” Run from anyone using that term!
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And the only way to stop it is to stop taking that particular drug. The drug is the cause. I have never seen any kind of side effect “medication” be truly effective in stopping this, though such medications do exist.
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I am familiar with Invega. It is an antipsychotic and most definitely could and often does cause akathesia and movement disorders.
You found the right way to respond. When there’s no button, just go back to the last one that HAS a respond button and use it, and your comment ends up at the end of the queue.
If you still want to write, I’m at [email protected]
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I have always thought we needed safe spaces for people to go to when they are feeling or acting out of control, but to unlink that from “diagnosis” and “treatment” unless that’s something the person wants or relates to. Folks can write “advance directives” for times they are unable to decide. But it’s certain we need safe spaces for people to destimulate from whatever is upsetting them. The idea that being held in such a place necessitates drug “treatment” is where I object to the process.
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What drug is causing the akathesia?
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“What About Bob” is priceless! One of my all-time favorites!
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“This suggests a treatment culture that diverges from guideline recommendations, where symptom-targeted prescribing prevails despite the risks of side effects and overmedication”
Doesn’t this prescribe mainstream psychiatric practice? What are they doing other than “symptom-targeted prescribing?” Seems like the only tool they have in their “toolbox” for the most part.
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I am so sorry you had to go through that!
But don’t imagine that “having depression” would have meant any different result. Brain damage is brain damage, regardless of one’s “diagnosis.”
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Not to mention, those receiving neuroleptics die decades before the average person. They are actually killing people slowly with their “treatments.”
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You are a truth speaker. Those afraid of the truth will find you threatening and often be hostile toward you. I’ve found the same myself. I’m a perfectly kind and cooperative person in general, but I speak up when something is wrong. And some people (especially doctors) seem to have difficulty with this concept.
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Quite so. It is a typical “blame the victim” scenario, and blaming fat people for being fat due to some character flaw is very much accepted in our culture.
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I don’t either. Knowingly creating harm through fraudulent representations and blaming of the victim. Particularly egregious when the clients are young and involuntary, not in a position to defend themselves or often even understand they are under assault.
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How anyone imagines that inducing a seizure through electrocution can be anything but harmful to the brain is truly beyond comprehension!
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I worked with kids in foster care taking Zyprexa or other fat-inducing antipsychotics, and saw psychiatrists frequently put them on diets and exercise regimes, never telling them that their weight gain was caused or exacerbated by the drugs. I saw one case where a kid in recovery from an eating disorder was given stimulants. When she stopped eating, they treated her like her ‘eating disorder’ came back, rather than recognizing (as my CASA volunteer observed and informed them) that her loss of appetite was due to the foolish decision to give her stimulants! Another kid became psychotic on stimulants (which happens in close to 7% of the cases, per a Canadian J Psychiatry study), yet she was given a psychotic disorder NOS diagnosis and prescribed antipsychotics. She only stopped being psychotic after SHE decided to stop all the drugs! Another got diagnosed with diabetes, which disappeared when she stopped taking Seroquel at the CASA volunteer’s behest.
The ability and willingness to ignore the obvious connections between drug administration and behavioral/physiological adverse reactions seems endemic to psychiatry. If the person gets better, it’s always attributed to the drugs, but if they get worse, it’s “the disease” rearing its ugly head, even if the drugs are the obvious cause.
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There is a difference in my mind between “authoritative” (able to take charge as needed and help keep things in order) vs. “authoritarian,” which to me means attached to power and willing to use it to keep “subordinates” in their place in the hierarchy. Doctors who believe patients should just “do as they are told” are the ones I think are most dangerous. I don’t mind my doctor having a strong opinion and expressing it, but I have the right to do the same, and if s/he can’t acknowledge that, s/he will quickly become my former doctor!
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I don’t know how many, but it’s not a trivial number. And of course many should never have been approved in the first place but are still in use today. That’s why truly informed consent matters so much these days. Even the doctors don’t seem to know all the adverse effects that are acknowledged, and of course the drug companies only publish the ones they are forced to by the FDA. We are really on our own when it comes to protecting ourselves against dangerous drugs, but most people don’t realize that until something bad happens, and sometimes it’s too late!
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I still think medical doctors need to be much more flexible and honest about side effects and options and alternatives. They also often exercise the option to be defensive when getting something wrong. Remember that most stimulants and antidepressants are prescribed by non-psychiatric doctors.
Plus my experience with cancer treatment tells me that most doctors don’t really know about the drugs they prescribe. I recently experienced a sudden and dramatic recovery from significant anemia after discontinuing one blood pressure drug (Losartan) at my own behest. Sure enough, looking up that drug immediately showed red blood cell production to be suppressed in rare cases, but particularly if one is over 60 (which I am) and takes it for an extended period (which I had been). When I confronted the doctor about it, he said, “I’ve never seen that.” Well, now he has. But he didn’t even record the dramatic recovery in the chart notes. Just said I’d potentially lost some kind of protection against sudden heart attacks, “But I did not take up this issue with the patient.”
Doctors should advise. Patients should decide. Doctors should be honest and accept patient feedback. Even if they are “right,” authoritarian doctors prevent feedback and disempower clients. And empowered clients have better outcomes.
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Yeah, remember Vioxx? Caused strokes and heart disease, literally killed people, but the drug company buried the data until they’d made billions of dollars on this blockbuster drug. No one went to prison for this, either. Not even sure they were fined. It’s not a rare thing.
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It is true that many are driven to become therapists by a feeling of their own incompleteness or inadequacy. This in itself should not disqualify them, but they must have already dealt with these feelings effectively themselves and be relatively emotionally healthy in order NOT to take advantage of the noted power imbalance. I have found such people rare, either in or out of the therapeutic professions. Among psychiatrists, I’ve found them almost nonexistent. Doctors in general tend toward the authoritarian, I’d say, but the number of truly self-aware and non-authoritarian psychiatrists I’ve met over many years of working both within and on the edges of the system can be counted on one hand.
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The CLIENT should be the one who “balances the risks with the benefits.” Too many doctors, and especially psychiatrists, seem to think THEY get to make this assessment. It’s their job to outline the risks and benefits for the client. The client then gets to decide what the balance is. This is too often forgotten!
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Absolutely. But framed as “science”.
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Some researchers believe…
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I just resent it to “[email protected].” Maybe it’s gone in a junk/spam folder?
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Thank you, Rosalee. It has been quite a process so far, and still only 4 months in. But I have learned a lot about myself and finding my way. It’s a big change!
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Ah, but I DID often confide in my clients. I found self-disclosure to be a very powerful way to connect on a real level, even if there are some who would have criticized my “poor boundaries.” But I get where you’re coming from. I’ve always been a big fan of support groups NOT “facilitated by a professional.” Those who have been there and done that are usually the safest people to talk and share with. And again, finding a capable therapist is a challenging proposition. I was quite aggressive in my screening and prepared to drop the grief counselor at a moment’s notice if the process did not meet my needs. Most potential clients are not in a position to take such an assertive stance, nor are most aware that they need to. Only years of experiencing seeing how crappy the average therapy experience was led me to be able to take such steps. I certainly would never trust or assume that the therapist in question was competent or safe without thoroughly testing them out in ways that most people would not realize are necessary or have the skills to accomplish.
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I have had the same experience. It is next to impossible to find a doctor who truly supports withdrawal. Some will “allow” it but generally convey suspicion and condescension toward clients attempting this kind of effort. And if things deteriorate, most are very quickly told, “See, there is proof that you are relapsing and you need the ‘medication.'”
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Fava is brilliant.
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I think we’re all irrational to some degree. Which is why it’s silly to call some people “mentally ill” because they act in certain ways, since almost anyone could be so labeled in the right (or wrong) circumstances. I am sure I could get such a label slapped on me since my wife died, if I let anyone with the power close enough to do so. And yes, I do behave irrationally sometimes. It’s part of being human.
It is true that help of any sort is hampered by power dynamics, not just in therapy, of course, but with doctors, teachers, lawyers, social workers, and so on. Some people choose to take advantage of their one-up power situation, some don’t. To be useful, therapists would have to be trusted to step down from their one-up position. But of course, no one can guarantee that, which makes seeking a therapist fraught with potential harm. As I’ve said many times, the fact of being a therapist or having a degree is no guarantee of being helpful. It doesn’t even improve the odds.
However, I have seen some remarkable work done by therapists from time to time. I can’t dismiss it altogether as always being a bad thing, since I benefitted from a good therapist myself. But that was my good fortune. It was also back in the 80s, when therapists had not yet been trained to be DSM-compliant as most have today. I have, in fact, recently found a grief counselor who has been very helpful to me, and I appreciate her. But believe you me, I screened heavily before engaging with her, and told her what I expected and that I would only continue if those expectations were met. She wasn’t perfect (who is), but she accepted and acted on my feedback, and did provide some excellent support when I needed it. So have any number of friends I have relied on since the loss of my wife, including a local pastor with whom I am now good friends. Help comes from wherever it comes from, and just because power dynamics can be exercised by a provider doesn’t mean they will. It’s not quite that black and white to me.
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Yup. It’s not rocket science!
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I agree wholeheartedly with your proposed approach. Boundaries means saying “no” politely but firmly, not humiliating the client! And you are also correct to say that the power imbalance makes it too easy to be defensive and take out feelings on the client. It’s up to the therapist not to abuse the power imbalance, but I find few who really are capable of doing so.
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What about weaning off and replacing it with nothing? Is that real to you?
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Good for you. I’ve worked “behind enemy lines” myself and eventually felt I had to give it up. So little real care is happening!
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I absolutely support that he has the right to ask her not to record the sessions, and refusing the gift was the right thing to do. What I’m trying to say is that her decision to do so says something about HER and what her ideas, needs and motivations are. One can set expectations without engaging in power dynamics. Whatever the client does, whether it’s allowed to continue or not, provides an opportunity to understand her motivations and intentions and provides a pathway to understanding what is behind them. Which is, after all, what therapy is supposed to be about. Again, let’s say she’s agreed to a no-recording policy. The conversation can easily go to, “Do you remember signing the agreement not to record the sessions? So if you knew that, what made you feel that recording them was necessary?” Or words to that effect. Something is going on with her. You don’t have to allow her to keep recording sessions without humiliating her or making her feel small. After all, she IS the client – if she were entirely rational, why would she be needing therapy? Why not use the opportunity to explore what is underneath her behavior, rather than shaming her? That’s what I’m suggesting.
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“Boundaries” can be used as tools or weapons by the person with more power, hence the therapists. It can be a way to avoid the therapist’s own feelings and blame the client. That seems to me like what happened to the author.
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You are laboring under the illusion that those training therapists are doing so in accordance with what science shows to be most essential!
I’m also not too sure such training can be effective with just anyone. I think it requires a good bit of self-awareness that would require the therapist to deal with his/her own issues before assuming such a role. A lot of people are not interested in or are not capable of that level of self-awareness, and as such should probably be disallowed from ever becoming therapists. But of course, that assumes the TRAINERS and LICENSERS have that degree of self-awareness as well…
Bottom line, it’s kind of a long shot to find someone who really knows how to help. And I don’t know how to screen them except for personal experience. It’s a conundrum, especially when folks are often getting paid for providing little or for making things worse!
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I don’t agree. Catherine is not responsible to gain Eugene’s trust. It’s the other way around. If she were recording me, I’d be saying, “That’s an interesting decision you made there. Why did you think it was important to record our conversations?” It would not be at all threatening – just another opportunity to develop the relationship with the client.
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Because when comparing results of different “styles” or “schools” of therapy, none of them were consistently superior. The ONLY variable that consistently predicted better outcomes was the quality of relationship with the therapist. If people felt safe and heard and believed, they did better. If they saw the therapist as aloof or distant or dismissive or invalidative, they did worse. It is kind of that simple.
Of course, as we have said multiple times before, therapists are not especially more likely than the general public to have these skills. Science has supported that, too. You’re just as likely to feel helped by a friend or neighbor or colleague as a therapist. It all comes down to good listening and being there for the person, wherever they are at. IMHO.
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That is just awful! Criminal, really. They know this can happen but don’t even bother telling their patients or their relatives/carers that it’s possible, and then when it happens, they blame the patient or “his disease!” I’m so, so sorry you have had to deal with this. I agree, fines are not sufficient. Jail time is appropriate!
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It is extremely disingenuous for psychiatrists to blame patients’ misconceptions about drugs and “diagnoses” on the pharmaceutical industry. They’ve been foursquare walking together the entire time since the DSM III in 1980. As for Risperdal, the “off-label” use of these drugs is rampant, for kids, the elderly, and even as an (PLEASE!) adjunct for “antidepressants!” Off label use is legal but needs to be reined in, as far as I’m concerned. It’s dangerous!
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You sound like “one of the good ones,” Hoda. You are right, it’s all about the relationship. Science has shown that to be the case, yet we continue to train people to “have boundaries” by denying the basic humanity of one person communicating honestly with another. Techniques can be handy, but truly caring and being deeply curious about the client are essential for any kind of success. Plus being humble and flexible, to do what works FOR THIS CLIENT instead of what someone says you’re supposed to do!
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Every study has limitations. Honestly acknowledging them is good science.
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