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Beyond antipsychiatry? The politics of mental illness

Biological psychiatry is currently facing pervasive challenges to its hegemony. Mental illness has gained massive recognition and medical treatments for such disorders are virtually ubiquitous. At the same time, the field is beset by scandals around kickbacks from drug companies, embroiled in divisive arguments over its diagnostic bible (the DSM-V) and finding it ever harder to provide conclusive scientific proof of its effectiveness. The psychiatric profession is facing a crisis of confidence bigger than at the height of the antipsychiatry movements of the 1960s and 70s.

'Doctoring the mind'In the middle of this comes a compelling critique of some of psychiatry’s key claims by Richard Bentall, a UK clinical psychologist working within the NHS. In Doctoring The Mind: Why Psychiatric Treatments Fail, Bentall provides a lucid and accessible account of the meagre successes and substantial failures of psychiatry, following on from his earlier Madness Explained. Unlike many critics of the discipline, he remains committed to a scientific understanding, which he calls ‘rational antipsychiatry’.

Bentall starts with Emil Kraepelin, a German psychiatrist who meticulously studied asylum inmates over many years and from this defined the major diagnoses now known as schizophrenia and bipolar disorder. This sets the scene for criticism of a profession firmly rooted in a biological, medical-model frame. Following this are some shocking tales of asylum conditions, as well as the use of brutal and ineffective physical treatments for insanity, including insulin coma therapy and lobotomies (the latter winning one of psychiatry’s few Nobel Prizes). The 1950s breakthrough with the antipsychotic drug chlorpromazine, far from being a win for psychiatric research, is revealed as an accidental crossover from anaesthetics. Yet soon such medications were being used in massive doses, producing debilitating side effects and new suffering for patients.

Lobotomy operationIn the context of anti-authoritarian social movements in the 1960s and 70s there emerged critiques like those of Thomas Szasz, RD Laing and Michel Foucault, sharing a view of psychiatry as a tool of social control resting on the subjective opinions of an uncaring medical elite. The crisis for mainstream psychiatry was worst in the United States, but a counter-movement soon developed, calling itself ‘neo-Kraepelinian’ and committed to reasserting the scientific (read: ‘biological’) basis of illness and treatment. This is the current that has dominated psychiatry since the DSM-III came out in 1980.

Yet, as Bentall shows, this renaissance rests on shaky foundations. Diagnosis is based purely on symptoms and behaviours, with heavy diagnostic overlap and poor reliability. It is not at all clear that DSM ‘disorders’ are discrete illnesses in the manner of, say, tuberculosis. Bentall counterposes a symptom-based approach, for example treating low mood, voices or paranoid beliefs each on their own merits.

He then debunks the idea that mental illnesses are simple products of genes. Mental illness is much more likely to be a complex result of the interplay of genetic and environmental factors, the latter both physical and non-physical. Bentall also shows that despite evidence that people with mental illness have (on average) different brain structure and function to ‘normals’, this doesn’t represent proof the causal chain must run from brain to mind.

Bentall concludes by scrutinising modern treatments. His grasp of the details of research methodology is reflected in clear explanations of the limitations of drug treatments and the Randomised Controlled Trials that have become the benchmark of ‘evidence-based medicine’. He explores the malign influence of Big Pharma in distorting science, leading to the production of expensive and harmful ‘new generation’ drugs marketed via aggressive promotion and bribery. Finally, he calls for a compassionate approach to treatment, suggesting clinical psychology as a relatively harmless but potentially powerful weapon for clinicians if they can just let go of their medical model approach.

In my practice I have drawn many conclusions similar to Bentall’s. There are also numerous areas where I disagree. For example, while I agree shock therapy is too often used inappropriately, in a narrow range of serious conditions its safety and efficacy actually have more evidence behind them than many of the drug or psychological treatments Bentall prefers. He also overplays the malice or ideological zeal behind past asylum conditions; most often they reflected the disinterest of the state in providing decent care for a highly marginalised social group. And in positing psychotherapies as the alternative to drug treatments in severe mental illness, Bentall is more projecting his hopes than any conclusive results.

Asylum

But such differences can be forgiven – after all, Bentall’s book is a polemic. Its real limitation is a silence on the biggest theoretical and procedural gap in psychiatry itself – its dis-integration from the social organisation in which it has developed.

This is tied up with an uncritical view that ‘real’ medicine not only deals with real (i.e. biological) illnesses, it does so much more effectively than psychiatry does with mental illness. Yet medical illness is as much socially constructed as mental disorder. Behind each may lie particular processes in the natural and/or social realms, but they are only ‘illnesses’ once they are socially defined as such, invariably because they have an impact on social life that is considered harmful in some way*.

Such an understanding is not about relativism. Not any definition of what is an ‘illness’ will do. But such definitions are a product of specific, historical social processes, whose meaning can only be judged if one also has a theory of social structure and change. All illness is essentially deviancy from social norms, which themselves must be understood concretely. To be a critic of psychiatry requires more than having a more robust set of research trials to refer to, it means having a thoroughgoing social critique. Furthermore, it helps us to understand why there are struggles over ‘what is illness and what isn’t’, and whose interests different definitions serve. By taking an approach that suggests mental problems cannot be defined as illnesses – only as symptoms – Bentall misses such considerations.

While Bentall locates many mistakes in the overreach of a particular, narrow conception of science, he has no explanation for why that overreach occurs or how one could replace it with something better. In the same vein, despite some references to the constraints of the medical model more generally, he effectively lets it off the hook by exaggerating its achievements. Yet the problems he identifies with psychiatry – reductionism, neglect of social factors, commercial distortions, etc – operate across medicine.

Bentall seems to be a progressive, but he also accepts many of the ideological presuppositions of capitalist society. For example, he doesn’t question that psychiatry and psychology accept the centrality of the individual subject (‘self’) for study and treatment, a variation on methodological individualism. And his claims for a different research project for mental health are based more on a moral appeal than any systematic alternative to the corporate and state driven edifice that currently exists.

Consider these facts. Among the rich nations various mental disorders occur at higher rates in more unequal societies. There is growing evidence that pressure on people to succeed individually in a market society is deleterious to mental health. And the incidence, expression and impact of even allegedly ‘biological’ illnesses like schizophrenia vary widely across cultures, suggesting they too are socially mediated (though probably very differently to garden-variety anxiety or depression).

It is important that critics like Richard Bentall have shaken the complacent assumptions of mainstream psychiatry, but not sufficient. Bentall ultimately misses the fact that the achievement of genuine mental health cannot be divorced from the achievement of a healthy social organisation. It is not, then, a question of psychiatry versus antipsychiatry, but of addressing mental illness in the context of projects for social transformation.

*For these insights I am indebted to the book Psychopolitics (1982) by Peter Sedgwick

Comments

  1. Thanks Tad. Great review. I too enjoyed the book and found it a really interesting read, but obviously I’m less closely involved with the field (and less articulate in expressing my views)so good to have this brief. Issues close to my heart.

  2. Pingback: Beyond antipsychiatry? The politics of mental illness « Overland … : Schizophrenia Page

  3. Hi Tad. Thanks for the post. I thought of Joshua Wolf Shenk’s marvellous book, Lincoln’s Melancholy, in which he traces a line between the high incidence of depression in men during the mid 19th century, westward push into the American frontier. Shenk suggests that Lincoln’s chronic depression was typical of those who felt they had failed to make the promised fortune evoked in the call the ‘go west young man’. Lincoln himself had experienced failures in business prior to entering politics.

    I suggest a similar dynamic is endemic in contemporary Australia. Many men suffer a quiet but lethal performance anxiety resulting from a failure, real or imagined, to ‘live the dream’.

  4. Good Evening Tad

    Thank you for reviewing this book. It warms my heart that psychiatry is undergoing such scrutiny and critique. And I appreciate your call for mental health to be placed within the context of a healthy society. A perspective of mine is that psychiatry is fundamentally flawed due to its ‘some people are more equal than others’ attitude.

    I cannot understand why mental health ‘professionals’ think it is OK to force another person to undergo treatment. I mean, in what other area of medicine does a ‘client’ have absolutely no say in how they approach their health and resolve illness?

    So back to your call for placing mental health within a social context and my claim of its inadequacy at the most basic level – until people with mental health issues are treated as people with equal rights, psychiatry cannot even make a beginning.

    Regards

    Michelle

  5. Thanks for the kind comments, Chris, Boris & Michelle.

    Michelle, I should declare my conflict here in that my job as a psychiatrist means that I do exercise powers of detention and coercive treatment. Clearly this is an ethical and political minefield, and I have recently been involved in campaigning against the erosion of rights for the mentally ill in NSW (see my Crikey article on the issues here: http://left-flank.blogspot.com/2010/10/nsw-government-takes-rights-of-mentally.html ), an issue which has been taken up by Greens MP John Kaye.

    However, I don’t think the distinction between psychiatry and the rest of medicine is as clear as you suggest. Non-consensual and coercive treatment happens a lot in medicine, especially in emergency situations and where there is diminished capacity due to disorders such as Alzheimer dementia. Plus, the relationship between doctor and patient is one riddled by assymetries of knowledge and power that make true “informed consent” an ideal rather than a reality. That’s part of the reason I think that drawing distinctions between psychiatry and other medicine is arbitrary and unhelpful; medicine itself is socially constructed and subject to the same problems as psychiatry.

    Let’s take an example from psychiatry, however. Most of my job is in emergency psychiatry, and the rapid sedation of highly distressed, agitated and/or violent patients is often not consensual. Yet the vast majority of those patients subsequently report they are glad we settled their behaviour and distress even though they were in no position to make a reasoned choice at the time, particularly because when they are in a distressed mental state they can cause significant harm to themselves and/or others. In that sense, there cannot be a clear “absolute” right to refuse treatment, because that presupposes an absolute autonomy of thought and action.

    Such issues become murkier under capitalism because the things that impinge on individual decision-making are well beyond the control of individuals. Not only the influences of Big Pharma or the state or medical elitism on doctors, but also the myriad social pressures that lead people to become patients. So I can be upset about the medicalisation of human sadness as “major depression” but also who am I to deny treatment (as some psychiatrists want to do) for the distress caused by living in a society as unequal and alienated as the present one? These issues cannot be settled through arguments about the over-reach of psychiatry unless we also have a project for social transformation that situates issues of “rights” in something wider than an abstract absolute.

    Let me be clear, I am not suggesting that psychiatry is free of sin with regards its malign social uses (or common, everday, petty abuses). But recognising its deeply contradictory character under capitalism means understanding the positive aspects as well as the negative.

    • Good Evening Tad

      Thank you for your response. I will try to clarify what I mean when I say that psychiatry is distinct from other areas of medicine in terms of (non) consent for treatment. Say you are a dietician and I tell you I am 200kg, eat McDonalds for breakfast, KFC for lunch, and Pizza Hut for dinner, sit in my chair in front of the tv all day and smoke dozens of cigarettes per hour. I am actively harming myself… yes? As a dietician is there a law backing you up allowing you to force me to undergo treatment, taking away my legal rights of choice and freedom…?

      I appreciate your reference to emergency situations, if a person is clearly unable to decide what should happen with their body (resulting from a car accident, a drug overdose, a severe psychotic episode, etc…) then health care professionals will make the decisions they deem most appropriate at the time, to save the persons life. However, when does this emergency state end with people who are experiencing mental illness?

      Your reasons for taking away choice regarding treatment are based upon Kantian ethics? People with a mental illness do particularly badly within this ethical framework as they are not considered purely rational beings possessing what Kant calls an ‘autonomous self regulating will’. Its a shame medical ethics in relation to mental illness in australia today are based upon a 200 year old german thought.

      Regarding psychiatry and capitalism, well… I have done one year of sociology at uni so will attempt to understand what you are getting at…. ummm… it seems that a neo liberal atmosphere combined with capitalism champions the individual, both praising and expecting individuals to be self sufficient, within a ‘market’ which rewards individual endeavour. At the same time this belief allows the government to reduce its responsibility in regards to providing for its citizens. So within a health context, people who experience regular illness, may not be able to completely provide for themselves, may need help from the government in terms of concessions and social security. But… as people who are not self sufficient are positioned as ‘failures’ in a neo liberal capitalist society, the government is justified when reducing publically provided social supports and promoting privatisation (of the health industry). ?

      Thank you again for responding to my post.

      Regards

      Michelle

      • I’m not into Kantian ethics, and so my reference to autonomy is a more general statement that no human being is truly autonomous. We’re all members of a complex social organism that has a past as well as a present, and so people make history but not in circumstances of their own choosing.

        That is why I reject absolute sanctions on involuntary treatment. Firstly because there are levels of coercion and power asymmetry in all medical settings, not just ones where a legal instrument is used. To take your example of the person eating themselves to death, currently there is increasing social pressure and calls for punitive measures to force such people to change their individual “lifestyles” or face denial of treatment. Many people suffering these problems face not just the growing social stigma around their situation but increased pressure on them as an individual to change their ways. And to argue that their habits are a rational choice, given the multitude of negative pressures people face that lead them to engage in what others see as self-defeating behaviour, only plays into the notions of methodological individualism that are so pernicious.

        Secondly because even in chronic illnesses, prolonged involuntary treatment can be justifiable in the patient’s interest, particularly if they suffer from an illness where lack of treatment causes a severe disconnection of their ability to mentally process their situation and choices. Of course today’s health services are thoroughly underfunded and inadequate, and overly focused on a narrow approach to treatment, but that is not a reason by itself to deny some effective treatment in certain circumstances.

        Thirdly because there is a social aspect to the manifestation of any person’s illness. What if their chronic delusions lead them to repeatedly assault others when treatment both relieves their distress and decreases the risk of such harm? It would be hard to argue that even in an egalitarian society that such harm should be allowed to persist in the interests of the individual patient’s right to be make their own choices. Patients are part of a social organism; the problem today is that our society is shaped by the needs of a small elite to dominate the rest of us, and so any coercive treatment runs the risk of falling into this logic.

        I’m not saying there are easy answers to these issues, but that seeking absolute individual rights as the solution is unsatisfactory. Indeed, I think that we will be unable to navigate all these contradictions without also transforming the social organism itself.

  6. So within a health context, people who experience regular illness, may not be able to completely provide for themselves, may need help from the government in terms of concessions and social security. But… as people who are not self sufficient are positioned as ‘failures’ in a neo liberal capitalist society, the government is justified when reducing publically provided social supports and promoting privatisation (of the health industry). ?

    I think it means that governments and health insurance companies will promote treatments such as CBT, in which the individual is solely responsible for his/her problems due to his/her own alleged irrationality. This betrays a great many assumptions on the part of the CBT ‘therapist’ – rationality (of an extremely narrow and ill-defined sort) is equated with health, the link between narcissism and ‘health’ is passed over in silence, and, rather than change the world, the individual suffering from ‘cognitive distortions’ is asked to change his/her mind instead. This latter occurs through a process of indoctrination and coercion which, whilst subtler than ECT and shackles, is far more insidious in its effects.

    • Much of the push to widen the definition of what is a “mental disorder” has been tied up with a “happiness” agenda that is well deconstructed by Barbara Ehrenreich in her book “Smile Or Die”.

      More generally, as with “physical” illness, a significant part of the motivation for treatment under capitalism is associated with the need to have a functional workforce even as capitalist class relations, work organisation and alienation (understood here in Marx’s sense) create the opposite — illness and disability.

      But the difficult question for socially committed clinicians is whether that means we should deny people amelioration of their illnesses because treatment is part of a social control process… and the treatment of the ‘flu is as relevant here as the treatment of “depression”.

      I would contend it is not enough to simply assert that because the ruling class benefits from a healthy workforce we should deny workers treatment. But it also means trying to be clear when we are taking social action to ameliorate social conditions, and when we are simply providing respite for an individual suffering because of the system.

      • More generally, as with “physical” illness, a significant part of the motivation for treatment under capitalism is associated with the need to have a functional workforce even as capitalist class relations, work organisation and alienation (understood here in Marx’s sense) create the opposite — illness and disability.

        Yes, which is precisely the reason why depression has been targetted in recent times – it inhibits the ability to both produce and consume.

        But the difficult question for socially committed clinicians is whether that means we should deny people amelioration of their illnesses because treatment is part of a social control process… and the treatment of the ‘flu is as relevant here as the treatment of “depression”.

        The flu is one thing, psychiatric illness is another. Opinions differ very widely as to what ameliorates something like depression, and there are some very good arguments that CBT (for instance) is worse than useless. Despite the consumerism of the mental health industry, a patient is not yet wholly a ‘client’, and a clinician ought not to accede to every demand a patient makes. In any event, I don’t think there’s anything wrong with trying to help a patient by means that don’t further indoctrinate or coerce them. In this regard, SSRIs are probably far less noxious than highly directive ‘therapies’ which seek to instil an instrumental reason which rules over the patient.

  7. Good Afternoon Tad

    Thank you for your eloquent response. It is nice, nice. I agree we are all members in a social organism, and no one is truly autonomous. The most difficult thing to learn in my first sociology class was not the various theories and theorists, but to realise I am living within a social organism that both restrains and creates my ‘choices’.

    I was not arguing my ‘overweight’ person made an autonomous, rational and individual decision to be this way. I can see that our society in many ways, creates illness. To be considered physically healthy, after I have worked an average full time week, I need to find time to exercise. Perhaps in response to a get fit campaign, perhaps because I like it, perhaps to generate enough physical energy to not only get through to the end of the week but to enjoy it. I then need to feed myself, so I jump in my car (if I have one), drive past the local fish and chip shop, get to the supermarket and walk through the aisles of food stuff that may be in cans or only require me to add water, to arrive at the fruit and vegetable section and pick out some nutritious, delicious foods. Then I have to come home and find time and energy to cook them. I acknowledge health depends both on individuals and the society we live within. My point is that as my dietician, you cannot legally force me to be thin.

    Your third point offends me greatly. Every time I argue that people with a mental illness should have a legal right to choose (or not choose) their treatment, some one will always bring up the… but if they are not forced to accept treatment they will all walk around punching people in the face. Grrrr. Of course it is not acceptable for people to be violent and assault others. But by using this example you are adding to the discriminatory, unfounded myth that all mentally ill people who are not receiving treatment will run around wreaking havoc. Please step outside your emergency room and tell me what % of people with a mental illness are actively violent. (an arbitrary question I know). It is a very small %. Why should all people who have a mental illness lose their legal right to choice and freedom when only a tiny number of people with a mental illness repeatedly assault others?

    I am not budging from my original assertion that people with mental health issues are people who should have equal legal rights regarding choice and freedom.

    Now, for transforming the social organism… how to continue? I always love to jump on ‘the media’s’ back. I mean, the oligopoly (small elite seeking to dominate the rest of us?) controlling opinion and information in australia is of paramount concern for people interested in democracy, freedom and society. However… we are currently in ‘the media’, people respectfully discussing diverse opinions, with some depth, seeking social transformation.

    Nice, nice.

    Regards

    Michelle

    • Michelle, I suspect you’ve misunderstood my third point. I’d be the last person to argue that “all mentally ill people” are violent. Depending on what type of mental health problem people have, they can be on average more, less or equally violent as the population average.

      It is also a judgement about whether their violence is directly related to some problem with mental function that leads them to hurt others on a spurious basis (e.g a delusional belief that God is telling them to) or whether it is simply a result of them lashing out while distressed. Often such distinctions cannot be easily assessed but that doesn’t mean they’re not important.

      The flipside of allowing absolute free choice around treatment is that the mental illness defence should be dropped from the criminal code also.

      Please don’t assume that I am uncritical of an overuse of involuntary treatment, and the ways that the current neoliberal order, with its obsession with risk and social control leads to both greater misery and greater use of coercive powers. But you need to make a case for why involuntary treatment should be eliminated that goes beyond an assertion of abstract equal rights when it is not clear that people always have the same level of capacity to make decisions, and nor would they if we lived in a truly egalitarian society.

  8. Just to declare my hand (so to speak) as well. I work at the NSW Guardianship Tribunal, an orgaanistaion that can be involved in taking away people’s legal right to make their own decisions. Mainly this relates to clients with dementia, but also intellectual disabilities, brain injury, mental illness etc. The Tribunal also gets involved in substitute medical consent. I spend a lot of my time explaining why orders need to be an option of last resort, why the least restrictive options are best, the importance of due process, procedural fairness etc. You sure see a lot of what is not great about society (the horror stories are really horrible), and while it’s by no means a perfect system at least it does have some checks and balances and it does afford some protection to the vulnerable. Mental health, ageing and disability services are chronically under resourced and this has enormously deprimental effects of people’s lives. I agree with Tad’s points by and large – society provides a lot of stresses, but not enough supports.

  9. I’m a PhD student in philosophy (who also has a legal background working for a centre funded to give advice and representation at ‘both’ ends of the revolving door – the mental health review board hearings and guardianship/administration hearings, AND the criminal charges where one usually argues that the client’s severe mental illness was a strongly mitigatory factor and the sentence should be limited to an order to comply with the instructions of his treating psychiatrist regarding treatment (that often being preferable to an outright ‘insanity defence’, which in WA leaves the client detained indefinitely ‘at the governor’s pleasure’).

    I haven’t yet finished my PhD but I HAVE had 3 articles publised, 2 (well, one and a clarification to responses) in the cross-discipline Philosophy, Psychiatry and Psychology and one in the Journal of Applied Philosophy. I endeavour to stick strongly to the ethical and legal side of things, staying as far away from the medical issues as possible – philosophers make asses of themselves when they try to write on matters of medical expertise. So when I talk about ‘mental illness’, I am really interested in what mitigates moral responsibility – one of my critics points out that my definition excludes paedophilia, but that’s my point – I’m interested in the conditions that deprive a person of moral responsibility, which paedophilia does not (I don’t deny it may be an illness from a medical perspective).

    Anyway, to the point: when writing each of these papers I emailed the heads of psychiatry at each hospital in Perth, begging them to pass on to their peers my request to correspond via email on the matter, or at least to ask whether they would receive my draft. I did not receive a single reply from any of them, which was extremely disappointing. This is particularly so as I do not see myself as advancing anything like a ‘radical anti-psychiaty’ agenda – I make no comment at all on treatment (it would be WELL beyond the scope of my book), and if I had to I’d argue that there is greater dignity in treatment through medication than psychotherapy based around telling people that their ways of thinking are somehow ‘inferior’ or that they don’t ‘really’ know their own thoughts. My arguments that there are moral and cultural aspects to identifying a mental condition as an illness are explicitly no different to what I believe happens with physical illness (in fact, my belief in the moral dimension of mental diagnosis came FROM my observation that such a moral dimension exists in traditional physical illness). I do argue a liberal line on involuntary treatment, but that is hardly unusual, and in many ways my position is highly permissive of involuntary treatment compared to most liberal philosophy. But for whatever reason, I received no reply – not even a response saying they were too busy to give feedback.

    I’d still love to get a psychiatrist’s view on the papers, even post-publication, and so I write to you with the same hope,

    The first 2 of the papers DID deal with the matter of what ‘counts’ as medical illness, though I tried to stay out of the medical territory and within the moral/legal territory as much as possible (so it’s more: what kind of conditions permit us to do bad things while receiving no moral blame? I failed to adequately clarify that in my first published paper). I reach the conclusion that in both mental AND PHYSICAL ILLNESS there must be a moral choice being made. E.g. (to use an example from physical illness) I doubt that ANY sophisticated culture could construe cancer as anything but an illness, but examples abound of lesser physical conditions that are illnesses in some cultures but not others. Similarly, schizophrenia is VERY widely treated as an illness accross cultures (sufferers are excused of wrongdoing and are often detained for their own benefit – though many non-western cultures put us to shame when it comes to their re-acceptance of the sufferer back into society during perioods of remission).

    If you’re interested, I’d LOVE your input. I’m not sure whether I can email them directly – I’d have to check the publication agreement to ensure that I’m not breaching the journal’s intellectual property. Nonetheless, if you have acccess to a university research database, you can read them through the journal databases (just do a search for ‘Ethical issues in the classification of mental conditions as mental illness’ and ‘Changing Functions, Moral responsibility and Mental Illness’ – I’d ask you to read both together as the latter, only a couple of pages, makes some important clarifications to the former. My other published essay ‘Beyond Mental Competence’ is a justification of extending paternalistic intervention to cases where such intervention is typically uncontroversial but, as I see it, stretches the meaning of ‘mental incompetence’ so far that it risks depriving the term of all justificatory reasoning). If you can’t access them that way, then email me (I presume you receive a copy of the email above) and I’ll see what I can do.

    Cheers, and thanks for the good work.

  10. I seen them I tried to speak to them. I could have been robbed, murdered…anything and I could have done nothing. I

    don’t know what we said. I could not get awake. Could not keep my eyes open for anyone or anything. They needed

    me I think. Phones, rings, texts…I think they need me too….I can’t stay awake…Got to call Dr. for myself and my

    loved one…He will never give you more than you can bear….Define bear…Gotta sleep
    This was a post I made on my page on Facebook this morning November of 2011. I got a few replies of people

    concerned for me and offers of help if I needed to talk. I also received alot of calls, asking what that was all about

    and it’s embarassing and people will think your crazy. Well I guess I am a little crazy. Aren’t we all in some fashion?
    I am so sick of society acting like nothing is going on. Like there are not many people out here crying out in so many

    ways for help. Help doesn’t come. Not the way it’s needed anyway. The doctors pump you full of pills and want to

    see you back in 3 months. The psychiatrists same thing more pills. The counselors sit and wait for you to tell them

    what’s wrong with you. And you wait for 2 weeks to months to even see someone. But we are living this nightmare

    every single day. Friends and family don’t know what to do with you. They either get tired of dealing with you or they

    think your faking or can just make it go away. Most often they avoid you because the fear for you and themselvesis

    too much for them. Your spouse or mate gets sick of it and gets angry and frusturated with you and just wants you to

    shut up and get better already. Then in many cases the inevitable happens. You end up with a loved one with the

    same illness and now you are trying to deal with your illness and theirs and your heart is ripping in two because you

    don’t know how to make it go away for the one you love and you feel such guilt for giving them this illness. Your

    afraid to die because you don’t know how they will now survive. And you neglect the others who need you in your

    family because you are so tied up in your illnesses. Then of course you get advice from professionals, family and

    friends alike. Let them take responsibility for themselves. Theres no reason they can’t make it on their own. While

    you see them suffering terribly each and every day and know from watching them and your own experience…that is not

    always how it works.
    I am so sick and tired of people judging. People that have never had to go through this or people that have or are

    going through it but just don’t have it as bad or maybe they’re stronger or have a better support group. Hell I don’t

    know. But don’t they stop to realize that if we could live…I mean really live not just exist that we would. Don’t they

    know that we would love to Live more than anything else in life at this point? Then the worst is when you start telling

    your loved one the same bullshit. Get out there and do it. Get past the fear. What’s going to happen when I’m gone

    then where are you going to be? You watch the pain and hurt in their eyes. Knowing that they can’t help what is

    going on in their minds, but the fear you have for them and their ability to survive is so strong that you say and do the

    same stupid things to them that are done to you and didn’t do a Damn bit of good. Lord help me I don’t know what to

    do. I can hardly take care of myself. Now how am I going to take care of this person that I love with all my heart

    also. I do though and find myself gettting worse and worse. The worry is overwhelming. I hurt by these words of so

    called wisdom that everyone feeds me, when all I want to do is hold that person and cry and cry and tell them I’m

    sorry….I don’t know how to help you. I’m sorry I passed this on to you. I’m sorry I don’t have any real answers.
    Since my loved one has become ill my fear of dying has become all consuming. I have severe panic attacks constantly

    and I beg them each time at the ER to not let me die. My loved one needs me. I can’t die. I just can’t. I feel

    myself beginning to pass out as my blood pressure and pulse rate drops. And I fight with everything I have in me not

    to let myself pass out for fear that I will never wake up and noone will be there to care for them.
    But I’m not supposed to talk about this. I try to explain, but how can they understand. I get angry then I remind

    myself their is no way they can understand something they have never experienced. In this paticular case I couldn’t

    wake up. I wanted to wake up. I needed to wake up as you can see in my post in the very first paragraph. I could

    not come fully awake and would fall asleep while trying to do anything. The post was made during that time. Yes I

    know it sounds crazy, I know it sounds desperate, but guess what…I am desperate. Why pretend I’m not.
    I just had a conversation with my loved one after they attempting yet once again to work. The job sent them by

    ambulance to the hospital because they didn’t know if they were having a heart attack or an anxiety attack. My loved

    one was scared shitless. Turns out it was a panic attack with a nice mix of dehydration and sugar being high. So

    now we need to find out if they are diabetic. They were just diagnosed with Bipolar 6 months ago and now Panic

    disorder. They have a rare form of back disease also they found in the last 6 months. But their just lazy you know.

    Just babied too much. So yeah I gave them the old pep talk. You’ve got to fight through this. You have to work

    through it and keep a job. Otherwise how will you be able to support yourself. What are you gonna do when I’m

    gone. You are too young to get on disability and even if you do you can’t possibly live on it since you have never

    kept a job for more than 6 months. Can you really not do it or is it just easier to live off me. All the time I see the

    hurt and the holding of the chest while I know their heart is racing. What the hell is the matter with me? Why do I

    listen to these people and project this nonsense. For this I am very sorry. I feel what you are feeling I know how

    disabilitating it is.
    Doctors, Psychiatrists, Therapists, Counselors. They try. I’m not ragging on them. I think they simply just don’t

    know. I don’t think anyone does. You can go in a center for a couple of weeks while they keep you heavily drugged

    and make sure you don’t hurt yourself. They can give you drugs that are supposed to help. They can give you

    appointments to keep every few weeks or most often once a month. But a person needs so much more than that. And

    then theres the fact when you are in this condition you have no job so no insurance and if your a single person your

    really screwed because theyre are not programs out there for you. If there are it is a sliding scale and cost of drugs

    reduced so you can get help with these reduced costs with the no money that you have. So of course familys

    supposed to kick in and make sure this can be taken care of right? Well generally with this type of illness your family

    members have it too so they have no money, insurance etc. either. So your all living in the same situation with the

    same hopeless despair. I am lucky enough I have a spouse that does not have an illness and does have a job so can

    keep a roof over our heads, but he has no insurance either. So no help at all there.
    I know I know everybodys got their hand out for a free ride. No-one wants to work for a living right?? Thats what

    they tell me. That’s what I hear the politicians say and people all around me. Well WRONG!! You self rightous

    people that do not live the life we live don’t know what in the hell your talking about! Take a walk in my shoes for

    awhile. I did not choose this. I worked and made a good living for myself prior to this happening. I was a High

    School Graduate with no further education who worked on the floor in a factory and worked hard to work myself up

    through the ranks and made it all the way to a Corporate position through my hard work. Then in the year 2001 I got

    slammed. I was sent from specialist to specialist. Must be my heart, Muscular Scerosis, oh we think you have a rare

    disease we will need to send you to Mayo Clinic to find out what it is…went on for nearly two years before they found

    out I had a panic disorder. By that time I was being rushed to the hospital by ambulance weekly from work and from

    home. I thought I was dying. I thought I was loosing my mind. My limbs would go weak on me and I would just fall

    to the floor. I was waking up in the middle of the night feeling like I wasn’t real and seeing fog like clouds all around

    me. I felt like I was trying to pass out all the time. My heart was beating so hard and fast I could see and feel it

    through my shirt. I would lay on the floor feeling my grip on my sanity leaving me. I would have chest pains, arms

    would go numb ice would run through my body. I would be driving down the road and it would become so severe I

    would pull off the road and sit there and tremble and cry in fear. The parametics would hook me up to the heart thing

    they have in the ambulance and it would show I was having heart issues. My blood pressure would sky rocket or it

    would drop out. But in the end it was always the same. They couldn’t find anything wrong with me through all the

    tests they did. I have been on medication after medication. I have been in hopsitals more times than I can count. I

    have been in the Stress Center. I have been to counselors, Psychiatrists. I’ve practiced Cognitive therapy.

    Meditation. I have had breakdowns driving, in Walmart, in Barber shops, in Restaurants, in peoples homes, at work at

    home. I stayed in my home for nearly a year at one point. And that’s just panic disorder. I since have been put on

    medication for the panic, depression, hypertension, high cholesterol, acid reflux, diabetes. I did continue to work

    during all of this. I worked with it for 9 years. Till it became such a problem HR spoke to me and reluctuntly had to

    let me go. They advised that I would not continue to be able to maintain work in this condition.
    Does it sound like I’m feeling sorry for myself? Damn straight I am! I am sick and tired of being sick and tired. I

    want me. I want to live!!
    So now my loved one gets to have all of it too only they get to have a little bonus of the Bipolar with psychotic

    episodes to go with it.
    There are no support groups around here. No special jobs for someone with this type of illness. What is a person

    supposed to do tell me….What?? Don’t give me this crap either of just work through it. Magically get the money and

    medications you need. Magically work while you are flopping on the floor like a fish. See how many employers want

    to keep someone that is doing that or can only work when their not in full blown panic or having a psychotic episode.

    Yeah they will get right on that and be glad to have you and keep you for an employee. Try getting a job with such a

    shitty work history because of all the jobs you’ve lost due to this crap. Prospective employer I have missed alot of

    work got fired from most for attendance. I would love to work for you I will not be able to make it in some days

    because I will wake up with panic and wont be able to drive myself to work and wont be able to work once I get there.

    But on the days that I can get there I will do a good job for you until it hits again then I wont be able to focus and I

    might drop to the floor and need to lay there for 10 or 15 minutes. I may be a safety liability when during one of these

    episodes. The cost of my medical care will make your insurance rates go up. But I’m a good person. I’m honest. I’m

    kind. I want to be able to work and make money and have a place to live. So can I have the job?
    I will not apologize for this post. I am not going to worry what people might think of me. I am posting to get it all off

    my chest and tell it like it is and to hopefully let all of you out there that suffer with these types of issues know. You

    are not alone. They’re are many of us out here some able to function and carry on with their jobs and some that are

    not. Each and everyone of you are valuable. Deserving of Love. Deserving of respect and kindness. And deserve to

    not be judged by another human being. You have no reason to be embarassed. You did not ask for this no more

    than the next person asked for cancer or any other type of illness.
    Do not ask me who my loved ones are. The who’s don’t matter. The illness and recognition of the need for more

    research, more means of emotional and financial support and alot less judgment is the message…and of course to let

    all of you out there suffering from the same or similar issues. I understand. You are not a freak and you are not

    alone!! Stand up and be counted. So the stigma and shame can be taken away from this. And we can all come

    together and offer compassion and support to each other. And maybe someday for those that do not suffer a greater

    understanding.

  11. Connie, I am very sad that your post has been here for over a week with no acknowledgement from anyone.

    I hear you and can relate to your distress. Being disabled due to mental illness is like a living death.

    I don’t have any magic words to help you, but wonder if you know about online support groups such as dailystrength.org where you can receive and give support to people who understand. You might find a little solace there, then again, you might not.

  12. “What if their chronic delusions lead them repeatedly to assault others…”

    You’ve just characterized what psychiatrists have generally been doing for the past 200 years. I’m not buying into the idea that psychiatrists should be the occupants of a legally privileged position that empowers them to go around assaulting people, on the fraudulent pretext of treating mental illnesses.

    If you were to juxtapose the aggregate violence and consequent harm committed by so-called psychotics with the aggregate violence committed by psychiatrists, there would be no comparison. You attach what ever linguistic tinsel to what you do that you want; if the sine qua non of the relationship between patient and psychiatrist isn’t fulfilled, namely, consent, then much of what psychiatrists is in contradistinction to the ideological labels and phrases that are designed to support and legitimate psychiatric violence. It is violence, not “treatment” or “care”. Your rationalizations disguised as rationales are meaningless; all criminals have an excuse.

    As far as I’m concerned, your powers of detention and coercion exclude you from the debate, because your very career and self-esteem is contingent upon conformity with the official doctrine, and doing these terrible things to people brings in its train, for the perpetrator of these acts, a need to pacify his/her conscience with self-serving explanations that validate the action, also making you susceptible to manipulation of the truth for your own benefit. Therefore, I think this renders your observations and explanations at least suspect.

    You say that non-consensual treatment happens a lot in other medical professions. Although there is truth in this, the first point that must be made is that it is nowhere near as ubiquitous a factor in the history of other medical professions. It has been and remains the paradigmatic policy of psychiatry. This accounts for the existence of mental health liberation and patient’s rights movements, which in my opinion reflects the gravity of the problem.

    You cannot prove that the patient is lacking an autonomy of thought and action, yet this does not lead us inescapably to the conclusion that the patient must be treated against his will anyway. That is your opinion, and psychiatrists are not in possession of infallible powers of observation.

    You say that the vast majority of patients were glad for the intervention. Even if what you say is true (though I am not going to just take your word for it, because it would be highly unlikely that you would say anything else), I fail to see why psychiatrists should expect their beliefs to entitle them to go around imposing their beliefs on other people. I expect no such entitlements for my own beliefs. What hubris!

    Maybe they were retrospectively grateful for the intervention because they had been cowed into submission, recognizing the futility of further resistence, fearing the possibility of being retraumatized? The reasons for this could be many, but when the patient says what strikes a receptive chord in the psychiatrist, all of a sudden the patient’s word is sacrosanct. If only the patient’s verbal productions were always so honoured!

    You talk of highly distressed, violent and/or agitated patients. Of course, it wouldn’t fit into your self-suporting, self-legitimating interpretative scheme to discuss the causal role the immediate environment might play in all this, instead you make the fundamental attribution error so common in the particular environment where you operate. When the fox is surrounded by hounds, it bares its teeth.

    One of the reasons why people should have a right to make decisions about treatment, inter alia, is because the history of your profession protests against the conceit that psychiatrists know what is in the best interests of the patient. The tragedy consequent upon this hubristic belief is testified to eloquently by history, which also testfies to just how vulnerable to delusional thinking are the psychiatrists, whose delusions are of course never scrutinized through a framework of possible symptomatic significance, no matter how much more dangerous the delusions of shrinks usually are.

    Psychiatrists are not Untermenschen. They are human beings to which the limitations of the species are applicable. As a result of these limitations, our powers must be limited also. Involuntary treatment has been far too harmful for far too many of its supposed beneficiaries for psychiatrists to make a reasonable claim to be deserving of such powers. Psychiatrists are labouring under similar delusions about the efficacy of their treatment today as they were in the past.

    You talk about violence caused by a patient’s delusion that god is telling him to do it. Who will protect us from the violence and consequent injury occasioned by YOUR delusions?

  13. Thank you Robyn. I firmly believe that psychiatry is actually a quasi religious belief system. Trying to bring in the scientific stuff and you feel you’re at a Flat Earth Society meeting. I have huge problems with ECT and am appalled, yet again, by the almost word for word establishment description of its “value” as a “therapy” made by you,Tad Tietze…Quote: “shock therapy is…in a narrow range of serious conditions…its SAFETY AND EFFICACY actually have more evidence behind them than many of the drug or psychological treatments…” ECT is neither of these things and there is a growing body of evidence to support this. Even if it is considered better than other treatments this merely points to the dismal inefficacy of all the others. After all it is now official that the antidepressants of today are to be considered no better than placebo. The “chemical imbalance in the brain” is totally discredited world wide. In fact, Ireland has forbidden Klaxo Smith Kline to use the term at all in ANY advertising. (They are also about to scrap involuntary psychiatry). And, in 2012 the Serotonin Theory of Depression was publicly scrapped by the psychiatric profession. Boy, aren’t there going to be some red faces around here. I tackled the boss of SANE Australia a few months ago with this one. He pompously replied that I was wrong and pointed at some mostly inept research that was to prove it. Suggestions/vague possibilities at best, and my response to that was not acknowledged.
    ECT has always caused enormous injury to tens of thousands of people for the best part of 75 years, and you all know that. Every time you advise a patient to have ECT and you suggest that they have one or other of the modes of treatment you say one does less damage than another. If it doesn’t cause damage, how can you have less of it? The “fleeting” memory loss is mentioned, in passing, the cognitive dysfunction is not. The permanency of these outcomes is virtually denied, with a claim is that only 1:200 will have permanent memory damage. Again, the cognitive injury is not mentioned. When asked what facts that figure was based on, the researcher said that there was no evidence, that he had made it up. This 1:200 figure was actually closer to, (1:70-80), the death rate in patients over 65 as documented in California, Texas, Massechusetts, where there is compulsory reporting of ALL ECT outcomes. Thatyou have gone on record with your “safety and efficacy” claim is a fair indication that you have not done your homework.
    Here are some quack claims over the years, from long ago where they admitted knowing it caused harm, to today when they don’t seem to believe that.??
    1…ECT works by “abolishing pathological experiences”, “total dissolution of brain function, i.e. damaging the brain and/or erasing memories of painful experiences.”
    Oh that it could be that delicate, but at 450 volts, with 140 “ultra brief” pulses a second for 5.3 seconds, I don’t think so. And again…
    2…“shock treatment is not harmful, and although it might cause some limited memory loss, it only eliminates unhappy or depressing memories.”
    Wouldn’t that be lovely. But whilst childbirth may not be the most comfortable of experiences, losing the memory of your first-born’s birth is unlikely to be considered an “unhappy” memory.
    3…the procedure does induce seizures, but they’re not painful and don’t cause convulsions…”
    Dear me, how much did he pay for his degree?
    4… “The reduction of intelligence is an important factor in the curative process… the fact is that some of the very best cures that one gets are in those individuals whom one reduces almost to amentia (feeble-mindedness)”
    Another one for welfare.
    5…”We considered a patient had regressed sufficiently when he wet and soiled, or acted and talked like a child of four….
Sometimes the confusion passes rapidly and patients act as if they had awakened from dreaming; their minds seem like clean slates upon which we can write.” In whose image? Playing GOD?
    Believe it or not these are not the silliest, or the most chilling.
    However, in 2007, and you should have known this by now, in 2010, Dr. Harold Sackheim, for over 25 years the leading researcher into ECT, after years of denying ANY permanent brain damage, admitted, along with his co-reseacher Joan Prudic that ECT did indeed cause permanent, severe brain damage in well over 50% of its recipients. (2007), that: “virtually all patients experience some degree of persistent and likely permanent amnesia… [and in some people] the memory loss extending back years prior to receipt of the treatment.” Further, “People can lose years of their lives.” He also conceded that ECT causes frontal lobe damage significantly affecting the brain’s executive functions: including working memory, logical reasoning and abstraction, problem solving, planning and organising.”
    My query is, how are you allowed to cause permanent and often crippling brain damage to at least one person in every two people they treat? What other part of medical practice would be allowed to do that? Why is it `open-season’ on psychiatric patients, do they not deserve the protection by the state that everyone else gets?
    Australia leads the world in its use of ECT, probably because Medicare pays the bill. How can you continue to use a treatment whose record of efficacy is so dismal that it keeps having to be repeated again and again until the individual becomes so damaged that they don’t know they are damaged. Until depression, which, though painful, means you were alive and had hope, is replaced by a passive, emotionless state from which there will be no recovery.
    Unmentioned go the psychological devastation. From Lucy Johnstone’s study in 1999:  
    ‘It was like I was a non-person and it didn’t matter what anybody did to me.’… ‘It felt like I had been got at, yes, bashed, abused, as if my brain had been abused. It did feel like an assault.’… ‘My memory is terrible, absolutely terrible. I can’t even remember Sarah’s first steps, and thaI’s really hurtful.. .Losing the memory of the kids growing up was awful.’… ‘It’s a void, I can’t describe it ,and there’s also a feeling of something fundamental that I don’t even know what it is missing…Just like an intrinsic part of me that I feel isn’t there and it was once….Part of it feels like there was a real death of something, something died during that time.’
    Why do they have the right to do this to desperate people who come to you for help?

    Try this one: “1996 — AccoPsychiatrists don’t make much money, and by practicing ECT they can bring their income almost up to the level of the family practitioner or internist” .
CONRAD SWARTZ (U.S. psychiatrist), in Dennis Cauchon, “Shock Therapy,” USA Today, 6 December 1995. Swartz is co-owner of Somatics, Inc., manufacturer of the Thymatron ECT device.
    Nothing’s changed. There are doctors out there, including one Josh Geffen from Queensland, seen happily admitting that he did 60 ECT treatments a week on SBS a couple of months ago. For this little effort, a few hours work on an ECT morning, he has to be getting at least $15,000 a week – and maybe up to double that. Our taxes at work!
    Let’s tell the health insurers, let’s tell medicare to check the repeat treatment rates, let’s tell the world Tad Tietze!
    You should have read Bentall & Read’s mega study of `sham’ (placebo trials) ECT- 2010
    Try Richard Warner’s `Efficacy, memory loss, and brain damage – Psychiatry’s don’t look, don’t tell policy 2005
    And how about: Robertson & Pryor’s – Memory and Cognitive effects of ECT: informing and assessing patients-2006
    There are many, many more. Once little of this could be found because the boards of the journals were peopled by the ECT lobby. Now we have the internet and freedom of information. The “sleeping” people are finding out. Litigation is beginning to move, even here.

  14. Hi Deirdre.

    This is what I wrote about ECT in the post above: “For example, while I agree shock therapy is too often used inappropriately, in a narrow range of serious conditions its safety and efficacy actually have more evidence behind them than many of the drug or psychological treatments Bentall prefers.”

    That is, I made a comparison of its safety and efficacy with those of other psychiatric and psychological treatments, not a statement about some kind of high level of safety and efficacy. The comparison is an entirely uncontroversial one if you look at the data.

    I was a general doctor for a decade before commencing psychiatric training, and in that time it was pretty obvious that a huge range of (non-psychiatric) medical treatments had nasty side-effects and limited effectiveness.

    Recent studies comparing the efficacy of widely used psychiatric and non-psychiatric medical treatments have been used to make the case that psychiatric treatments are similarly efficacious to non-psychiatric treatments. But you can read the results the other way, too, because overall efficacy is actually not very impressive in both groups, and so you could conclude that medical treatment in general is not crash hot, despite the inflated claims made for it. Indeed, it remains a fact that social and political measures have generally had much more positive impact on human health and illness than narrow modern technological medical treatments.

    In that sense, I think the argument you make about ECT is actually an argument against most medical treatments, unless you subscribe to the view that somehow mental health and illness are qualitatively different to health and illness in general. As should be clear from my review, I think such a position is untenable. That leaves us with weighing up the pros and cons of various interventions, but without using two sets of valuations: a soft one for general medicine and an impossibly tough one for psychiatry.

  15. “Let’s take an example from psychiatry, however. Most of my job is in emergency psychiatry, and the rapid sedation of highly distressed, agitated and/or violent patients is often not consensual. Yet the vast majority of those patients subsequently report they are glad we settled their behaviour and distress even though they were in no position to make a reasoned choice at the time, particularly because when they are in a distressed mental state they can cause significant harm to themselves and/or others. In that sense, there cannot be a clear “absolute” right to refuse treatment, because that presupposes an absolute autonomy of thought and action.”

    This is a self-serving statement from a person that forcibly drugs strangers. Strangers that have bodies he doesn’t demonstrate biological disease in. He chooses to spin this to the public as “sedating violent patients”. These people didn’t choose any doctor/patient relationship with him. They are CALLED “patients” against their will. They are in reality detainees. It is also no surprise that citizens arrested without having committed a crime, and taken to terrifying coercive psych wards against their will, will many times be outraged that such a thing is happening to them, and sometimes they do get violent yes. But locking up people on the basis of the content of their thoughts, and forcing quackery on them, is an act of violence in and of itself. When considering the issue of forced psychiatry, it is prudent not to just mindlessly accept the justifications given by professionals who cross this ethical line for a living. They’re often thoroughly brainwashed people who’ve spent a career initiating massive, violent, invasive chemical force against strangers and have learned ways to justify such things to themselves, it’s how they sleep at night. This alleged “doctor” (real doctors deal with real diseases), is certainly no supporter of human rights if he’s in the business of taking them away from people for a living.

    There is no moral justification for taking away the right of another to have their bodily integrity respected, especially when the violent quacks carrying out these assaults don’t even examine these bodies and prove disease.

    But the critics have only internet comments. And the perpetrators have the power to violently pour toxic drugs into the bodies of all their poor detainees. Sadly, might makes right in psychiatry and the oppressed won’t be liberated from this terror any time soon.

    No, they are just left to pick up the pieces after psychiatry has raped their minds with forced “treatments”.

    Never expect pity or mercy from someone who is paid to ignore those who plead with them not to inject them with drugs.

    I would hate to be “Dr” Ted and have all those assaults on my conscience. His self-serving claim that most of the people he forces drugs into later thank him, is obviously meant to provide him moral cover for the others who aren’t so thankful, who are left traumatized for the rest of their lives by such egregious human rights abuses. Not to mention many people just say what a psychiatrist wants to hear, so they can win their freedom earlier.

    His is an ugly, violent chosen career, to assault and invade the bodies of strangers for a living, and then claim to have some kind of political sensibility worth listening to, is truly delusional.

    I support Cledwyn Bulbs’ comment above.

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