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Post by Admin on Sept 21, 2020 22:50:18 GMT
A recent article in Vice, ostensibly about the critical psychiatry movement, discussed (and criticized) Mad in America without interviewing anyone from Mad in America, used misleading quotes from leading figures, and failed to present any evidence for their claims. Robert Whitaker responds. www.madinamerica.com/2020/09/vice-mia-and-the-movement-against-psychiatry/On August 26, VICE NEWS published a long article titled “The Movement Against Psychiatry.” The piece featured interviews with many people familiar to Mad in America readers, and Mad in America—this webzine—was also featured in the article, albeit at times in distinctly unflattering ways. The criticism of my book Anatomy of an Epidemic was something else altogether: it was an arrow aimed at the heart of all that we do. Criticism is nothing new to Mad in America, and personally I have had my fair share of it. And while it is often best just to shrug it off—after all, if you challenge a conventional narrative in society that brings prestige to a medical guild and billions in profits to pharmaceutical companies, you can expect slings and arrows to come your way—in this instance deconstructing the article and responding to the criticisms provides an opportunity that shouldn’t be passed up. Although Vice may not be “mainstream media,” it is a publishing venture that has gained a growing readership, particularly among younger adults, in the past few years. This article was also one of the first to report on the growing effort in American society to challenge the conventional narrative that psychiatry has told over the past 40 years. Thus, the article is of some importance in terms of societal understanding of this “movement against psychiatry.” The article provides a three-fold opportunity. First, it provides us at Mad in America with a reason to set forth a clear explanation of our mission and why we do what we do. Readers of Mad in America may not have a good understanding of this, and without that understanding, it limits the impact we can have on this discussion regarding the merits of psychiatric care today. Second, it provides us with an opportunity to publicly answer a criticism that defenders of the conventional narrative regularly make about me as the author of Anatomy of an Epidemic, and, to a lesser extent, a criticism of the Mad in America website. The criticism is that we distort the scientific record, and thus, our “critique” of the conventional narrative is an intellectually dishonest one. Vice aired this criticism the instant it introduced us into the article, and then sought to provide examples of this “distortion.” Thus, by examining those “examples,” it becomes possible for readers, in their own minds, to assess the merits of this criticism. If the Vice article provides evidence of a distortion of science in Anatomy of an Epidemic, and evidence that Mad in America commits the same sin in its coverage of scientific findings, then I think it would be best if we shut down Mad in America tomorrow. We would be doing harm. However, if a close reading of this article reveals the opposite, that in fact the criticisms are of a hollow kind, and that the examples cited in fact reveal an effort by defenders of the conventional narrative to explain away findings that belie their narrative, then the rebels—those said to be part of a “movement against psychiatry”—can take heart. They will know, more clearly than before, that science is on their side. Third, it provides an opportunity to see how the media itself, in its reporting on psychiatry and its treatments, is resistant to challenging the conventional narrative. The Vice article was presented as an exploration of the “movement against psychiatry,” and yet you can see, once it is deconstructed, how it told a story that surely pleased the promoters of the conventional narrative, and put the “critics” on the defensive at almost every turn. ________________________________________________________ The Movement Against Psychiatry The contentious debate of whether to fix—or completely overthrow—the way we treat mental illness. www.vice.com/en_us/article/qj4mmb/the-movement-against-psychiatryKim Stringer and Angela Peacock don’t know each other. Stringer, 28, lives in Bucks County, Pennsylvania and once had aspirations to be an artist. Peacock, 41, lives in upstate New York and is an Iraq war veteran. Both women sought help from the mental health system. They got very different results. Their stories reveal how people in emotional distress can be failed by psychiatry, and point to radically divergent conclusions about how to fix it. What happened to these two women embodies, more broadly, an embattled debate taking place in patient and provider communities around the world. Stringer’s mother, Martha, said that Stringer was diagnosed with bipolar disorder in high school, and given lithium and Seroquel. Shortly after graduating, Stringer told her parents she wouldn’t be taking medication anymore, or seeing her therapist. “We watched her steadily deteriorate,” Martha said. Martha and her husband have now spent eight years trying to get their daughter help, but as is the case in many U.S. states, Stringer cannot be involuntarily given treatment unless she poses an imminent risk to herself or others. Martha and her husband bought Stringer a house to live in because they didn’t want her to be homeless. Though they provided her with food, Stringer would go through dumpsters to find her meals. Her apartment was filled with rotting, open food containers, and smelled of urine. “She started pushing a shopping cart around the community and collecting trash and dead animals,” Martha said. “She got increasingly phobic around phones and technology, very fearful of computers, television, and radiation.” After multiple encounters with the police for erratic behavior, Stringer finally met the threshold of harm, but wasn't brought to the hospital. She was arrested and put into jail at the beginning of 2020. “From there, we were denied access and denied information, told that her needs were being met when they were not,” Martha said. Fellow inmates at Bucks County Correctional Facility contacted a local reporter about how Stringer had been “confined to a bare cell, completely naked in full view of male and female guards, with only a soiled blanket and a smock given to patients who are on suicide watch, which she rarely wears,” the reporter wrote in June. “She urinates and defecates on the floor and on herself. She has gone without a mattress at times and has no books or possessions. She is covered with bruises, and at times has hit her head or punched herself. She hasn’t had a shower in weeks.”
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Post by Admin on Sept 21, 2020 22:51:22 GMT
Have made this into a sticky, to post arguments from all sides.
Seems to be another area of total polarization.
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Post by Admin on Sept 22, 2020 10:00:13 GMT
Anti-Psychiatry A look at the anti-psychiatry movement. www.psychologistworld.com/issues/anti-psychiatryOrigins of anti-psychiatry The term 'anti-psychiatry' was first used by David Cooper in 1967, though opposition to either psychiatry in general, or its practices, predates this coinage; surrealism's opposition to psychiatry predates it by decades. Leading lights of the anti-psychiatry movement included Thomas Szasz and R. D. Laing, both psychiatrists. Other critics of psychiatry often associated with the anti-psychiatry movement include Dr. Peter Breggin and Jeffrey Moussaieff Masson, a psychoanalyst who uncovered evidence that Sigmund Freud had suppressed observations of child sexual abuse. Civil libertarianism has opposed psychiatry or abuses of psychiatry on constitutional or other legal grounds. Among popular movements against psychiatry are the Psychiatric survivors movement, persons charged with abuse based on repressed memories, political prisoners of totalitarian regimes, and certain documenters of the Nazi holocaust. The latter point out that systematic euthanasia of people in German institutions in the 1930s provided the institutional, procedural, and doctrinal origins of racial mass murder of the 1940s. The Nuremberg Trials convicted a number of physicians, mostly psychiatrists, who held key positions in both eras of Nazi murder. A sermon against the earlier practice by Bishop August Clemens Graf von Galen of Münster delivered on August 3, 1941 is credited with inspiring a group of young medical students to publish anti-Hitler pamphlets in 1942 and 1943 in the name of White Rose. Cooper was a Marxist, and indeed there has been a great challenge to conventional theories of psychiatry from Western believers in Marxism, but the anti-psychiatry movement is by no means homogenous ideologically, and Szasz approached anti-psychiatry from a civil libertarian perspective and challenged Cooper's Marxist beliefs. Many of their criticisms derived from the inhumane treatment of mental patients, either through the damaging effects of long-term institutionalisation or the use of specific interventions given without informed consent. Electroconvulsive therapy, or ECT, has been used to sedate and punish difficult psychiatric patients, rather than for therapeutic purposes. Others contend that even accepted therapeutic practices remain instruments of social control. Punitive use of "treatment", including ECT, isolation, and restraint has diminished, but is still widely documented to occur. (There has been a resurgence of ECT research and treatment in the past decade, for treatment of a wide range of mental illnesses including severe depression, but many things about ECT are still poorly understood, including exactly how ECT works, and opponents of the practice allege that ECT causes brain damage and has killed several patients on whom it was used, some without their consent.) Observation of the abuses of psychiatry in the Soviet Union also led to questioning of the validity of the practice of psychiatry in the West. (In particular, the diagnosis of political dissidents in the Russian Soviet Federated Socialist Republic (RSFSR) with sluggishly progressing schizophrenia, when compared to four different types of schizophrenia recognized in the West, led some to question the existence of schizophrenia.) The alleged practice of the United States Secret Service, endorsed by the agency, of attempting to get involuntarily committed those it perceives (its critics would have it, perceives or claims it perceives) to be a danger to its protectees, rather than because of their mental illness, is claimed by some to come closest to these Soviet practices. Others object to psychiatry not on these grounds, but on the grounds of the fact that the body of information making up the discipline consists mostly of vague and non-falsifiable hypotheses, or, worse, hypotheses not testable without resorting to unconscionable and inhumane experiments on human beings. As Karl Popper noted, if it isn't falsifiable, it isn't empirically testable--and if it is not empirically testable, it is not science at all. During the 1970s the anti-psychiatry movement acquired sufficient respectability to advocate restraint from the worst abuses prevalent in Psychiarty. Jurists such as David Bazelon brought legal force and stature to anti-psychiatry sentiments. Still, in the modern therapeutic culture with pharmaceuticals promising relief from all that ails, those who question the ethics and efficacy of psychiatric practice are far from mainstream.
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Post by Admin on Sept 22, 2020 10:01:51 GMT
Op-Ed: Why Anti-Psychiatry Now Fails and Harms — Formerly a healthy corrective, movement now distracts from real problems and actively hurts people by Jonathan Stea, PhD, RPsych, Tyler Black, MD, and Joseph Pierre, MD September 9, 2020 www.medpagetoday.com/psychiatry/generalpsychiatry/88526The evolution of modern psychiatry has at times been fraught, but the discipline has adapted and survived through periods of controversy. As with any scientific endeavor, self-criticism and self-correction are intentional built-in features required for growth that move us closer to truth. Disciplines that lack rigorous mechanisms for such interrogation, such as the peer-review process, are at risk of crossing the fuzzy boundary from science into pseudoscience. Medical disciplines that do not confront their tarnished pasts -- as all disciplines must -- will never grow to be better versions of human healing. Scientific criticism of psychiatry is therefore both necessary and healthy to the benefit of people who experience mental health concerns. But beyond scientific critique, psychiatry has long been a target of criticism that has been moralistic and ideological as well. Dating back to at least the 1960s, the so-called "anti-psychiatry" movement began as an understandable reaction to various missteps of psychiatry, such as the over-medicalization of mental health, the inhumane management of asylum care, and the inappropriate pathologizing of minority groups. In the early days of the movement, it might be said that "anti-psychiatry" helped psychiatry to self-correct in a way that moved the discipline towards a more scientific endeavor reliant on empiric evidence, while maintaining a sharp focus on the interaction between biological, psychological, and social contributions to mental health and illness. More recently, however, the anti-psychiatry movement has lost its way. It has transformed from a predominantly academic and political movement to one of consumer groups, akin to the anti-vaccine saga. In its current form, anti-psychiatry exists as a disorganized entity outside of mainstream medicine, largely propagated on social media and in non-peer-reviewed sources like newspaper opinion articles, books, and blogs that evade scientific dialogue and critique.
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Post by Admin on Sept 22, 2020 10:04:21 GMT
My own position on it all - i very strongly disagree with mental illness denial.
i do not agree with the abolition of psychiatry - But far rather it's reform.
The main issue for me is that people deserve better treatment - But that is as much a far wider societal / systemic - socioeconomic / political / human rights question as it is for psychiatry.
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Post by Admin on Sept 22, 2020 12:30:58 GMT
Medicating Normal is the untold story of what can happen when profit-driven medicine intersects with human beings in distress. medicatingnormal.com/mindfreedom.org/front-page/medicating-normal-screening/Primum non Nocere: A Psychiatrist’s Review of “Medicating Normal” By Awais Aftab July 12, 2020 awaisaftab.blogspot.com/2020/07/primum-non-nocere-psychiatrists-review.html"Yet to do so exclusively will also miss the larger point of the documentary. Psychiatry can continue to be aggrieved and defensive for good reasons, but in my view that is a precarious strategy and may simply be a recipe for future irrelevance. The conversation is no longer in the hands of the psychiatrists. The conversation has moved into the community. The pandora’s box is open. Many individuals have lost trust in the medical system, they have lost trust in organized psychiatry, they have lost faith in the ability of psychiatric diagnoses and medications to help them. These individuals are taking ownership of their distress and making sense of it in ways that speak to them in more authentic ways. Organized psychiatry has a choice to make here. It can continue to pretend that everything is hunky-dory, and it can continue to dismiss the experiences of harmed patients as anecdotal evidence. Or it can begin to acknowledge the reality of harmed patients, the myriad ways in which we have ignored them and let them down, the ways in which we have allowed the profit and greed of pharmaceutical companies to corrupt our science, and the ways in which we as a profession are failing to offer narratives to our patients that do not reduce their existence to disease and disability."
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Post by Admin on Sept 22, 2020 12:33:33 GMT
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Post by Admin on Sept 22, 2020 12:35:31 GMT
Anti-psychiatry From Wikipedia, the free encyclopedia en.wikipedia.org/wiki/Anti-psychiatryControversies about psychiatry From Wikipedia, the free encyclopedia en.wikipedia.org/wiki/Controversies_about_psychiatryAs long as psychiatry has existed it has been subject to controversy.[1] Psychiatric treatments are sometimes seen to be ultimately more damaging than helpful to patients. Psychiatry is sometimes thought to be a benign medical practice, but at times is seen by some as a coercive instrument of oppression. Psychiatry is seen to involve an unequal power relationship between doctor and patient, and critics of psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations[citation needed]. In 2013, psychiatrist Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".[1][2][3][4] Every society permits compulsory treatment of mental patients[citation needed].[1] Psychiatry's history involves what some view as dangerous treatments.[1] Electroconvulsive therapy is one of these, which was used widely between the 1930s and 1960s and is still in use today.[5][6] The brain surgery procedure lobotomy is another practice that was ultimately seen as too invasive and brutal.[4] Long term use of modern antipsychotic drugs also leads to l/oss of brain mass. The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role in many aspects of treatment.[1]
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Post by Admin on Sept 22, 2020 12:39:38 GMT
Anti-psychiatry From Wikipedia, the free encyclopedia en.wikipedia.org/wiki/Anti-psychiatryControversies about psychiatry From Wikipedia, the free encyclopedia en.wikipedia.org/wiki/Controversies_about_psychiatryAs long as psychiatry has existed it has been subject to controversy.[1] Psychiatric treatments are sometimes seen to be ultimately more damaging than helpful to patients. Psychiatry is sometimes thought to be a benign medical practice, but at times is seen by some as a coercive instrument of oppression. Psychiatry is seen to involve an unequal power relationship between doctor and patient, and critics of psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations[citation needed]. In 2013, psychiatrist Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".[1][2][3][4] Every society permits compulsory treatment of mental patients[citation needed].[1] Psychiatry's history involves what some view as dangerous treatments.[1] Electroconvulsive therapy is one of these, which was used widely between the 1930s and 1960s and is still in use today.[5][6] The brain surgery procedure lobotomy is another practice that was ultimately seen as too invasive and brutal.[4] Long term use of modern antipsychotic drugs also leads to l/oss of brain mass. The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role in many aspects of treatment.[1] Schizophrenia diagnosis en.wikipedia.org/wiki/Controversies_about_psychiatry#Schizophrenia_diagnosisMain article: Diagnosis of schizophrenia en.wikipedia.org/wiki/Diagnosis_of_schizophreniaUnderlying issues associated with schizophrenia would be better addressed as a spectrum of conditions[75] or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.[76] This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.[77][78][79] In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed nor false, and need not involve the presence of incontrovertible evidence.[80][81][82] Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability[citation needed]. She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation.[83][84] This view is supported by other psychiatrists.[85] In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM’s operational definition as the "true" construct of schizophrenia.[75] Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.[86][87] The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder.[85] Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.[88][89] The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.[90]
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Post by Admin on Sept 23, 2020 11:12:43 GMT
A Conversation with Nev Jones www.madinamerica.com/2020/09/a-conversation-with-nev-jones/Editor’s Note: This conversation arose after Vice published an article about the “The Movement Against Psychiatry.” Sandy Steingard and Nev Jones, who have both contributed to Mad in America through blogs and/or continuing education courses, were both quoted in that article as being somewhat critical of Mad in America’s mission. Sandy: We “met” sometime in 2012. You sent me an email in response to several of the blogs I had written on Mad in America. You were critical of some things that were—and remain—important to me: Anatomy of an Epidemic and Open Dialogue. At the time, many people were critical of my blogs but I was struck immediately by several things. First of all, you were not critical of me; it was clear that you were interested in a serious engagement about ideas. Second, you were approaching all of this from a very different perspective. Third, I was struck by your keen intellect. This led to an ongoing conversation that continues to this day and has been extremely valuable in my own intellectual development. I am wondering if you would expound on any of these ideas, either as you raised them way back when or as you consider them today. Nev: In the case of both Anatomy and Open Dialogue, I’d say that my underlying concerns were (and to some extent still are) similar—but these are also concerns, to be fair, that have always had as much or more to do with the way Anatomy and OD have been taken up in popular discourse (versus their original articulations). This in turn has always raised questions in my mind about the author/founder versus the life of ideas once they circulate in the world, and what responsibility, if any, the former bear. But this is a complex topic, unresolved in my mind. Meanwhile, my direct concerns were three-fold: first, oversimplification. Psychosis, for starters, is singularly heterogeneous, encompassing wildly different symptoms or experiences, levels of distress, and trajectories over time. We know there are demonstrable biological mechanisms at play in some cases (e.g., anti-NMDAR encephalitis) while voices can easily be induced through very short-term sleep deprivation and certainly also acute trauma. Social and structural factors—poverty, exclusion, deprivation—can of course also profoundly influence these experiences. And people react and respond very differently to various interventions, including antipsychotic drugs but also different psychological therapies (including cognitive remediation). And there is also a reality of very severe, enduring psychosis, the existence of which likely has little or nothing to do with exposure to antipsychotics or the lack thereof. And overall, there’s so much we don’t know, so much we don’t understand. So, acknowledging heterogeneity, acknowledging a very high degree of uncertainty about just about everything, including ways of addressing long-term disability—I personally see this as the necessary starting point of any discussion. Instead, at least at the time, I think it was common to see Open Dialogue deployed as a quasi-magical bullet and means of (for some people literally) eliminating psychosis. And likewise, I felt that many people took up Anatomy as ostensible proof that antipsychotics were the primary cause of sustained or chronic psychosis (through supersensitization) and also that the case was more or less settled with respect to long-term iatrogenic harms. A further concern is that, in both cases, a kind of “medication-centrism” seemed in play that in fact provided a potentially dangerous alibi for investments in social welfare, and programs to support those with long-term disability, as well as a kind of “invisibilization” of the fundamental role of poverty and structural marginalization (and the neoliberal economic policies responsible for them). Turning to Open Dialogue, for example, the idea that one could relatively neatly import an intervention from a rural, culturally homogeneous region of a high-income Nordic state with universal healthcare, robust social welfare systems, tuition free higher education, and so on, to parts of the US with deep poverty, entrenched structural racism, urban violence, etc., seemed like a fantasy. Sandy: It might be helpful for me to address why for me, as a psychiatrist, the questions Whitaker raised in Anatomy were important and why they have led to a shift in how I think about the drugs we prescribe. Prior to reading Anatomy, I was already alarmed at the influence the pharmaceutical industry exerted on the practice of psychiatry (and, to be fair, the entire medical enterprise). When the newer antipsychotic drugs (APDs) were introduced in the 1990s, I was initially hopeful but then I observed leaders of my profession seemingly colluding with the pharmaceutical industry in playing down their harms and supporting the expansion of their use. Prior to the approval of the newer drugs, leading psychiatrists were promoting low-dose use of APDs in recognition of their many harmful effects. Over time, this message was lost and a more promiscuous approach to prescribing proliferated. I never thought that was supported by the evidence base and it upset me. But Anatomy raised another concern, namely that their long-term use might worsen rather than enhance long-term outcome. Up until then, I agreed that these drugs (albeit at low doses) should generally be continued long-term to prevent relapse. I found Anatomy well-referenced but I read it as a hypothesis—a call to further study, a question as to whether this issue was as settled as most psychiatrists believed it was. I did not find that I could easily dismiss these concerns and that led to my reviewing many of the articles cited, talking to colleagues, and deconstructing my view on the optimal use of these drugs. But I agree that what I read as a call for further study, others read as a more definitive statement. I also think that you and I were talking to different groups. I was talking to psychiatrists and was frustrated by their general readiness to dismiss these ideas without further exploration and I gather you were talking to others who (in our opinion) may have been too eager to embrace them as definitive. We were both frustrated but at different kinds of reactions to the book. I have valued our exchanges because they helped me to think critically and expand my horizons for critical inquiry. I agree with you that psychosis is so varied that it is difficult to offer one guide to treatment. It does not comport with my own observations that all psychosis can be explained entirely as occurring as a consequence of a person’s life experiences. Nor do I think that exposure to psychoactive drugs accounts for all psychosis. But I do think that over decades, social influences on the development of psychosis have been minimized and psychosocial interventions have tended to be focused on rehabilitation and psychoeducation. In a general way, the skills required to help people make sense of extreme states have atrophied among members of the professional community. Most clinicians and families are taught to think about psychosis in medical terms and I think this is the direct result of a limited narrative regarding our understanding of these kinds of experiences. I have also come to believe that minimizing relapse risk might be not be the highest priority for everyone. This has important and serious implications for psychiatric practice. I agree that while I find Open Dialogue (OD) to be of great value, I feel caught sometime between those who think that either there is not enough evidence to support it yet too costly to fund studies that might provide such evidence, on the on hand, and those who idealize it and overstate our current knowledge base about it, on the other. I also have serious worries that if it is taken up without adequate attention to the way the drugs are used, the excellent outcomes reported in Western Lapland will not be replicated. But again, I became interested out of my curiosity and what I thought was an imperative to learn about other ways of working with people who were experiencing psychosis and it was that curiosity that also led me to Hearing Voices groups and Soteria. Nev: These comments are so helpful. First, it occurs to me that while you read and absorbed Anatomy as a practicing clinical psychiatrist who up to that point operated under the assumption that antipsychotics were essential to the treatment of psychosis for most people, I was coming from a place of intimate awareness of how painful any decision about initiating or sustaining antipsychotics nearly always is—for those experiencing psychosis, for their families, for other loved ones and close friends. And part of that is because just as “schizophrenia is not an illness like any other,” psychiatric medications are not medications like any other. Because in this domain, we’re up against what philosophers have described as the “hard question of consciousness”—how the “mind” and “brain” are related. And because this question sometimes seems irresolvable, society tends to fall back on dualism. And not just mind versus brain but a whole series of linked constructs: “mind” entailing constructs like activity/agency, moral responsibility, psychological therapy or self-help; and “brain” connoting passivity, freedom from responsibility, moral exculpation. And thus to choose to take an antipsychotic, or be seen as taking an antipsychotic, at least in social circles that have strongly embraced a “psychological” perspective, that choice easily becomes tied up in a moralizing, even neoliberal discourse. Hence the phenomena of “pill shaming.” And then if we introduce the argument that antipsychotics not only signal weakness but are actually “causal” contributors to chronic psychosis, then we make a set of decisions that are already deeply painful even harder. And, critically, I therefore think the standard of evidence, the depth of understanding, needs to be very high before we unleash these kinds of ideas on the public. And I don’t think we’re there by any stretch. As I said before, there are so many gaps in our knowledge and we cannot say with any certainty that any given person is better off discontinuing versus continuing antipsychotics. Hence, of course, my particular concerns about Anatomy and the way it was being read. Second, I suspect we’re in agreement regarding the importance of addressing poverty and structural racism (and of course one of the clearest manifestations of structural racism is the interlocking nature of poverty, class, and race), but I feel much less certain that addressing “medications” is actually a central piece of what we need to do. I’d almost call it more of an epiphenomenon. Addressing medicalization (or more precisely medical reductionism), on the other hand, is certainly critical. But here, I think, a huge part of the problem (and I’m largely following Helena Hansen’s argument in pathologizing poverty) is that contemporary welfare (workfare) policies operate in a way that first pushes people who are poor to claim disability, and then traps them within a disability-driven welfare system; similarly, the criminalization of substance use and (minor) drug trafficking, which have led to the highest rate of incarceration of any Western high-income country, and so disproportionately affected people of color, particularly black communities. In my mind, the importance of addressing these carceral and welfare policies are way higher on my list of priorities [than medication prescribing practices]. Sandy: Since the idea of this conversation came about as a result of the Shayla Love Vice article, I also wanted to circle back to that. We were both interviewed and while I appreciated the breadth of the article, I found it hard to understand the sequence or overarching theme of the piece. It may be that I am too immersed in this topic but it troubled me that there appeared to be an implied link between Scientology and critical perspectives. Also, I greatly value the work of Whitaker and MIA and I thought they were both treated unfairly. Your comments about Anatomy were critical; you were quoted as saying that Anatomy is “just packed with misinterpreted, misunderstood studies that Whitaker uses to make claims that I think are demonstrably untrue.” In the context of what you wrote above, is there anything you would want to add here? Nev: Yes, regarding the Vice article, I think my general reaction to that piece (and most mental health journalism I read) was, “Ah, this is why I’m a researcher and not a journalist.” In other words, I think the slow, rigorous, peer-review process involved in academic publications is really helpful—we have to review the literature, demonstrate understanding, and describe our methods and approach in a transparent way. Journalism, on the other hand, has none of the safeguards of qualitative research—there’s rarely anonymity, nothing like formal “informed consent”—and the goal most often seems to write a story that appeals to a popular audience, or that the author and/or editor imagines will. Thus “the story” becomes the focus rather than a careful, critical attempt to articulate themes (as well as thematic tensions) within a given set of interviews. So much of my actual conversation with Shayla focused on the consequences of political polarization (about medications, diagnosis, etc.) and the need to get beyond this and the challenges of doing justice to all sides; and this perspective is largely absent. Instead, a few sentences, stripped of their original context, are deployed in ways that seem less about doing justice to my perspective and more about carrying a certain narrative argument that the journalist wanted to make. As I’ve already mentioned, I do disagree with various arguments embedded in Anatomy, or at least find many of the arguments over-stated, or perhaps, as I’ve explained earlier, at least start down a path that ultimately de-centers issues of fundamental importance to improving the outcomes of people with psychosis/schizophrenia in the US. But then it’s more when I think of the way that some people have read (and interpreted) Anatomy—i.e. as definitive proof rather than a hypothesis-generating text—that I’ve tended to feel the most frustrated and concerned. Regardless, while I could certainly criticize the way the excerpted quote you mention is deployed, and question what it was Shayla Love thought this would achieve, I obviously also bear responsibility for saying it. And use of such strong language—”fighting words” even—actually violates my own principles of engagement and I would say in retrospect that it reflects frustration with threads within popular discourse that it’s unfair to ascribe(?) so strongly to Anatomy. And like Awais, my concerns with Mad in America, when I have them, are squarely with some of the blogs, not the scientific team, which does fantastic work and includes a number of very talented doctoral students. So all in all, it’s unfortunate the way this played out, which doesn’t seem to have contributed to greater dialogue—except maybe as the impetus for this conversation…? On the topic of “public uptake,” however, I’m really interested in your thoughts—for example, with respect to “medication-centrism.” What should our priorities be, from your perspective, and what are the risks of centering or prioritizing the topic of medications? Sandy: Right now, I do not know of any way to talk about reform of the mental health care system without addressing racism and the profound disparities we have in the US in outcomes among different groups. Addressing poverty is a part of that but we need to address structural racism. You are among the many who have taught me of the value of including those with lived experience into every part of our system—from working directly with individuals to developing policies, to setting research agendas to conducting research. Antiracism would also mean that BiPOC are also included, not in a tokenistic way but in all aspects of the system of care. I admit that I am worried that when we talk about access to care and problems of incarceration and poverty, if we do not also talk about the highly medicalized narrative that has taken hold in the US (and elsewhere), we might do as much harm as good. So I do not consider this an either/or proposition but a both/and. If, in my own writing, I focus on drugs, it is only because that is where I have some expertise. When it comes to dismantling hierarchical and racist structures, I support it but I am a student, not a leader. I have two final questions for you. The first is what your priorities are for the future. The second is how MIA might be helpful in advancing these priorities. Nev: When I was working in California, one of my projects investigated the impact of cumulative structural disadvantage (including structural racism, exposure to community violence, incarceration of family members during childhood, migration in adversity, individual trauma, and so on) on the outcomes of young people treated in specialized early psychosis programs. I looked at both engagement with services and outcomes. And the data I collected suggested that any effect of level of symptoms (impairment/distress) disappeared when we added cumulative disadvantage to our models. So, it seems to me, if the goal is really to provide better support to people, and to change outcomes, it is essential that we address these underlying conditions and the way they not only affect risk but also ongoing experiences. (For example, imagine trying to “manage” paranoia when you’re living in a neighborhood in which there’s a factually huge risk of getting shot just walking to the bus stop. Back when I was in Chicago, I literally heard this from research participants on the South Side, and in a couple of cases their voices actually played the role of warning them when it was unsafe to go out.) Addressing education and employment—access, affordability, and support—are also fundamental. My more “privileged” perspective on change is a different form of de-pathologization: beginning to see the experiences that get labeled as psychosis as rich, complicated, meaning-laden, and fundamentally bound up with identity and selfhood..and thus centering meaning-making in clinical contexts, rather than reductionistic forms of therapy or intervention that primarily aim to contain, ameliorate, or enable “self-management.” I also feel that these experiences need to be brought back into the fold of human experience and culture. And finally, certainly seats at the decision-making table for those with personal experience of significant psychiatric disabilities and intersecting experiences such as homelessness, living in subsidized housing, disability-based discrimination, and poverty. And of course, ensuring racial/ethnic/cultural minority representation and leadership within this mix. And I think we need to make sure that we are not excluding perspectives that we disagree with. In fact, they’re arguably the most important and represent the places where we have the most to learn. How can MIA contribute? Obviously there’s a very diverse mix of voices represented in current blogs, and the science team does really great work. But perhaps an even more explicit focus on user/survivor-led research? And more efforts to visibilize major policy issues (such as healthcare and welfare reform, underlying drivers of structural racism, macro policy issues more generally)? But also I would say explicit efforts to bring “critics” into the conversation (more university-based psychiatrists and researchers, for example)—and not just the choir, but rather, as I said above, creating dialogue among those with significant differences of perspective but doing so in ways that are generative rather than competitive. Not a debate but an opportunity for deeper (collective) reflection? But back atcha. What is your vision? Sandy: As someone who is critical, I often get asked about my vision and I struggle with an answer. One idea that I have advanced is the merger of Joanna Moncrieff’s drug-centered approach to psychopharmacotherapy and need-adapted treatment (NAT). I have written about this elsewhere, but in brief, this offers a way to reduce the reliance on a faulty diagnostic system and offer the space and time to discuss with individuals and families these extremely complex matters that you have raised. Psychiatric practice has evolved within the medical system where one—and this is anyone who bills an insurance system!—is obligated to arrive at a diagnosis and treatment plan quickly. Even if one does not adhere to an essentialist notion of mental disorder, the processes of assigning diagnoses tends to reify them in the minds of clinicians, individuals, and families. You write about agency and I have come to believe that we need to try to maximize a person’s sense of agency. You have also addressed how difficult it is for humans to tolerate uncertainty. NAT (Open Dialogue is the most widely known type of NAT) values uncertainty but, as important, it offers a place to discuss it and manage the difficulty of not knowing. It is less hierarchical and will encourage clinicians to tilt towards humility in their work. With everything we do not know, I believe the best clinicians are the ones who embrace humility. Beyond that, I think people need to listen to people like you. I am most excited about the work coming out of groups who have been—in varying degrees and ways—marginalized: people with lived experience, people of color (including professionals). This is likely to be published after I have retired from clinical work and I think the future is with you and not me. In that spirit, let me say that I remember when you first emailed me. I hope I am not too much of a fangirl by saying I have kept those emails and still learn from them. In the spirit of everything I have just written, I offer you the final word. Nev: Okay, last word! It’s going to be “dialogue”—because I think that greater user/survivor leadership and influence are absolutely critical, in part because of such a long history of exclusion and marginalization. But at the end of the day, we all need to join together to enact deeper social change. *** Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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Post by Admin on Sept 28, 2020 22:08:33 GMT
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Post by Admin on Oct 1, 2020 9:20:13 GMT
Is Psychiatry Dangerous? www.behaviorismandmentalhealth.com/2020/09/22/is-psychiatry-dangerous/On August 26, Shayla Love, senior staff writer, published a piece on VICE, an online magazine. The article is titled The Movement Against Psychiatry: The contentious debate of whether to fix—or completely overthrow—the way we treat mental illness. In her article, Ms. Love provides abundant quotes from people on both sides of the issue, including Awais Aftab, MD, an American psychiatrist, currently Clinical Assistant Professor of Psychiatry at Case Western Reserve University in Cleveland, Ohio, and Attending Psychiatrist at Northcoast Behavioral Healthcare. This agency is operated by the Ohio Department of Mental Health and Addiction Services (Ohio MHAS). On August 27, Dr. Aftab wrote a piece on his own blog, A Myth in Creation. The article is titled The VICE story: Beyond Anti-psychiatry. In his first paragraph, Dr. Aftab tells us that his purpose in writing the article was to “offer more context and background” to the quoted material in Ms. Love’s article. Here’s an interesting quote from Dr. Aftab’s article: “Because Mad in America has emerged as the major platform in the US for critical and dissatisfied voices, it demonstrates the full yin-yang messy complexity of the bad mixed in with the good and the good mixed in with the bad. Some felt that my comments were targeted specifically at MIA’s research news team, but that is not correct. When I said things like I ‘shake my head with disappointment’, it is with regards to blogs and articles such as this one.” The link in the above quote leads to an excellent and forthright post by Peter Breggin, MD, which he published on Mad in America on March 2, 2020. The post is titled The Most Dangerous Thing You Will Ever Do. The opening sentence states: “The most dangerous thing you will ever do is see a psychiatrist”.[Italics in original] The post is divided into sections with the following headings: How Psychiatric Drugs Take Your Mind Prisoner Withdrawal Symptoms Make Escape from the Drugs Extremely Difficult Psychiatry Itself is a Prison of Sorts Are Psychiatrists More Informed than Primary Care Physicians? Psychiatrists Are Extremely ignorant About Life How Shock Doctors Make Escape Totally Impossible The Risk of Getting Physically Locked Up Psychiatry Is an Alternative Reality Comparing the Good and the Bad Where and How to Get Help Here are some quotes from Dr. Breggin’s piece: “I am a psychiatrist and I have been watching my profession deteriorate for many decades. This is my most direct written statement about the dangers of stepping inside a modern psychiatrist’s office. My conclusions are the culmination of mountains of research authored by me and by an increasing number of other psychiatrists, scientists and journalists.” [Emphasis added] “All psychiatric drugs are potent neurotoxins that so disrupt higher mental functioning and emotional regulation that people taking them almost never have adequate awareness of how much harm the drugs are doing to their body, brain and mind, their energy and will power, and their overall quality of life.” “Meanwhile, psychiatrists will frequently cover up what is happening by telling their patients and their families that the drugs are needed and that the obvious symptoms of brain injury are instead products of the patient’s supposed mental illness.” “As a group, psychiatrists are by far the most arrogant and cavalier prescribers in the field of medicine.” “Most psychiatrists have not been adequately trained and have little interest in talking with people about their lives and how to live more effectively and happily.” “Because they know so little and have so little to offer, psychiatrists must dumb down and misguide both themselves and their patients about what really makes people suffer and what really helps them recover and lead good lives. Instead of wisdom and understanding they rely on cookie-cutter diagnoses and drugs. The great majority of psychiatrists know no other way to make a living than to act as medication dispensing machines, cramming multiple patients into an hour for “med checks,” and collecting a steady stream of reimbursements from the insurance companies and government programs.” “Even when the brains and minds of patients are being obliterated by continuous electroconvulsive therapy (ECT), usually along with multiple drugs, shock doctors regularly lie by saying that the massive memory loss and cognitive dysfunction is a result of their ‘mental illness.'” “Psychiatry has created an alternative reality or extreme state for itself…based on drug company marketing slogans, false science, fake medicine, and fabricated claims of superior knowledge.” “Even a good coach without professional credentials is likely to be safer and more helpful than a psychiatrist.” “I believe that a good therapist should be so helpful on the first visit that you feel eager to return for the next session and that you should be drug-free enough to enjoy and benefit from the help.” [Italics in original] So, just for the record, I wanted to state that unlike the very eminent Dr. Aftab, I, for one, do not find myself shaking my head with disappointment at Dr. Breggin’s article, but rather nodding my head in general agreement. I describe my agreement as “general” because there are some hyperbolic statements in the piece that are clearly not meant to be taken literally, e.g. the title. There are activities that are more dangerous than seeing a psychiatrist, e.g. playing “chicken” with trains at level crossings. I encourage my readers to take a look at Dr. Breggin’s article and to judge the matter for themselves. Meanwhile, it seems to me that Dr. Aftab’s comment about shaking his head in disappointment is a bit like lobbing a hand grenade into the enemy camp and running away. This might be a good tactic in mortal combat, but has little to commend it in the search for truth and validity in matters like the one to hand. In his August 27 post, Dr. Aftab wrote the following: “I am wary of extreme criticisms of psychiatry – of which there is no shortage – that rely on mischaracterizations, vitriol, and propaganda, and seek to delegitimize psychiatry as a medical specialty. Such views are typically characterized as “anti-psychiatry” but that is an imperfect term, because the term is at times applied rather liberally, the “classic” figures considered to be anti-psychiatrists rejected the label, and very few these days self-identify their views as being anti-psychiatry. As imperfect as the term is, there doesn’t seem to be a more suitable alternative for extreme views that rely on dangerous disinformation.” Note the opening of the quote – “I am wary of extreme criticisms of psychiatry – of which there is no shortage – that rely on mischaracterizations, vitriol, and propaganda, and seek to delegitimize psychiatry as a medical specialty.” There is an unspoken, but clearly implied, assertion here that “extreme” criticisms of psychiatry rely on “mischaracterization, vitriol, and propaganda”. But there is no mention of extreme criticisms that are based on rational, coherent, and valid assessments of psychiatry’s performance and value. Dr. Aftab seems to exclude such possibility from his analysis, which is the very definition of prejudice – a pre-conceived judgment or opinion. The fact of the matter is that psychiatry has, for decades, ignored criticism of the more gentle kind and has promoted its deceptive concepts and harmful practices with no regard, and often with unconcealed contempt, for alternative perspectives. For instance, on April 26, 2015, the very eminent and venerable psychiatrist, and past president of the APA, Jeffrey Lieberman, MD, speaking to Michael Enright on a Canadian Broadcasting Corporation interview, referred to Robert Whitaker as a “menace to society”. (starting at 0:50 of the provided audio link). So I ask Dr. Aftab, what steps should a conscientious objector take in these kinds of circumstances? Should we go on being polite and cordial (e.g., “Well I do have some minor reservations about some of the newer diagnoses…” etc), or should we meet measure with measure (e.g. “Psychiatry is not something basically good that needs some minor tweeking; rather it is something fundamentally deceptive and rotten”.)? I have adopted the latter perspective, as I am sure is clear from my writings. I have adopted this perspective, not because I wish to mischaracterize psychiatry. Indeed, I go to great pains to ensure that all my criticisms are founded. Nor do I have any interest in the spreading of vitriol or the promotion of propaganda. I have adopted my present position because, given the activities of psychiatry, the only appropriate response that is consistent with my conscience and with human decency is to call psychiatry out on their lies and harmful practices with all the vigor I am capable of mustering. I have seen too much of psychiatry’s works to mince my words. As for seeking “to delegitimize psychiatry”, I think that psychiatrists did this to themselves a long time ago. We members of the anti-psychiatry movement are simply chronicling the process. So, while Dr. Aftab shakes his head in sanctimonious disappointment, we on this side of the issue shake our heads in disbelief at the level of self-centered cynicism in his chosen occupation that routinely prioritizes considerations of turf, income, and prestige over truth, validity, and client welfare. And note particularly the final word in the quote: “disinformation”. Not misinformation, but disinformation, which is defined in my Merriam Webster’s Collegiate Dictionary as “false information deliberately and often covertly spread (as by the planting of rumors) in order to influence public opinion or obscure the truth“. [Emphasis added]
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Post by Admin on Oct 6, 2020 1:38:44 GMT
PSYCHIATRY'S DEHUMANIZING LANGUAGE.
"Psychiatry and some psychology create images of Man as something else, other than human. There are images of man as an animal, computer, system, machine or thing.
Picturing someone as less than human, makes it easier to treat him inhumanely.
Biological and genetic psychiatry dehumanise man by regarding him as an animal, while some psychiatry goes even further, dehumanising man to a machine. "What's Wrong With You?!" reflects the Broken Machine Model, the patient as a broken machine needing to be fixed.
The Broken Machine Model is worse than the Medical Model. See how psychiatry has deteriorated!
The terms, Adjustment or Maladjustment picture Man as a machine. This is the language of 'mechanistic dehumanisation', - the person as a machine or thing. So we get expressions like, "unbalanced", and "restore equilibrium"
The idea of 'Warehousing' patients in chronic facilities, or elderly in homes (or waiting to die places) conveys the image of people as disused stock, or things.
What do we make of a hurt child having a "Deficit Disorder" ? Deficit?
It's interesting the use of acronyms and initials, ADD and ODD, PTSD and OCD is similar to computer or electronic acronyms, SQL, COBOL, LED, DVD. A complex life's narrative and experience is reduced to a 'syndrome' or "disorder" or "imbalance".
What is your take on the term "Bipolar" for a living person's experience? An electromagnetic device oscillating between positive and negative poles? Bereavement and heartbreak are lost and forgotten in the term 'Disorder'. - Dehumanization.
What do we make of, feedback, conditioning, positive and negative reinforcement, stimulus-response? Reprogramming? Aren't these terms mechanistic? Dehumanizing?
The psychiatric persective is often Collectivism, as opposed to the idea that each individual is unique i.e. Individualism. Collectivism is another dehumanizing process. By abstacting humans out of their social context, psychiatrists dehumanize.
The belief that the entirety of human existence can be explained at a lower level like Billiard Balls and the laws of physics and chemistry is Reductionism.
This too is a dehumanizing philosophy.
Positivism in the social sciences including Psychiatry and Psychology is dehumanising! Much of Psychiatry and Psychology regards a Person as a Thing rather than a Person!
Objectification:
"In social philosophy, objectification means treating a person as a thing, without regard to their dignity." - Wikipedia. By not seeing their "patients"/clients as Agents, i.e beings with choice, Psychiatrists dehumanize."
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Post by Admin on Oct 24, 2020 12:35:06 GMT
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Post by Admin on Oct 31, 2020 19:42:28 GMT
Around the Web, from Mad in the UK: "In times past, the standard rebuttal to those who highlighted the lack of evidence for biomedically caused ‘mental disorders’ was some version of ‘yes, but we will obviously find evidence of this causation eventually’ which affirmed the approach but denied that there was a problem. It is increasingly common in current times, however, for critics to be dismissed on the grounds that psychiatry is not, as it apparently turns out, committed to biomedical causation/explanation after all." Are Critics of Psychiatry Stranded in a ‘Jurassic World?’www.madintheuk.com/2020/10/critics-psychiatry-stranded-jurassic-world/In a recent Psychiatric Times interview with Lucy Johnstone,1 the interviewer took the very unusual step of seeking ‘clarification’ from two psychiatrists that she mentioned in the interview. These ‘clarifications’ were then published at the end of the interview. One of these psychiatrists, the eminent professor Sir Robin Murray, concluded with the following statement: ‘Sadly, a few psychologists appear to have been stranded in a Jurassic world where they spend their energies railing against a type of psychiatry which became extinct years ago.’ This is a bold statement. It is also an increasingly common example of psychiatry’s critics being dismissed out of hand for allegedly being ‘out of touch’ with the theory and practice of modern psychiatry. In times past, the standard rebuttal to those who highlighted the lack of evidence for biomedically caused ‘mental disorders’ was some version of ‘yes, but we will obviously find evidence of this causation eventually’ which affirmed the approach but denied that there was a problem. It is increasingly common in current times, however, for critics to be dismissed on the grounds that psychiatry is not, as it apparently turns out, committed to biomedical causation/explanation after all. This is often accompanied by suggestions that such critics have not understood what psychiatry — and indeed medicine at large — actually does, and/or that psychiatric theory has evolved philosophically from its biomedical days and the conceptual naivety of the past has matured. Sir Robin Murray seems to be alluding to this kind of position. If true, this would obviously pose a problem for those critics of psychiatry. So, it would seem proper to examine the arguments behind these sorts of statements in order to see whether the critics are now in fact the naïve ones, or whether the charges brought against psychiatry remain valid. I will look at 3 core arguments below. 1. The Critical arguments about psychiatry argue against a ‘straw man’; we are ‘all biopsychosocial now.’ The first and the most common argument suggests that few psychiatrists (if any, according to some) actually practise the biomedical model of psychiatry. Rather, it will be said, psychiatrists (in the UK, at least) have been using the ‘biopsychosocial model’ for the past 40 years or so — since Engel’s seminal 1977 paper that birthed the term.2 Far from an exclusive focus on biological causes and treatments, the modern, practical application of Engel’s descriptive position purports to integrate the biological, psychological and social levels of experience in its psychiatric explanations and treatments. If this is indeed the norm, then it can be claimed that the ‘critical position’ is arguing against a straw man. Leaving aside the fact that the vast majority of psychiatric research to this very day concerns biomedical causes/explanations/treatments and that billions of dollars have been spent on such failed science over the last few decades; that claims such as ‘mental disorders are medical conditions just like heart disease or diabetes’, ‘mental disorders are brain disorders’, or ‘mental disorders are related to problems with chemistry in your brain’ are ubiquitous (found, for example, on the American Psychiatric Association website3); and that psychiatrists — despite allegedly thinking in this complex and integrative way for 40 years or so — are still rarely anything other than in the business of 15-minute ‘med reviews’, which cover status examinations, symptom/side effect descriptions, and/or changing from one drug to another — it’s important to understand what is actually being conveyed by the term, especially with regards to the ‘social’ aspect. The chief intended purpose of the term ‘biopsychosocial’ is to assert that unlike in the biomedical era ‘social causes’ are now permitted a place in the causal chains that psychiatry sees as leading to its ‘mental disorders.’ And it is true, psychiatry has indeed conceded such a causal role for some time now. To be fair, there is also an increasing emphasis on discussing social factors. But when one understands what the ‘social’ means in this context, the continuing allegiance to biomedical explanation becomes clear. For a model that purports to integrate social experiences, it is very strange that their lived, meaningful dimensions and idiosyncratic character are absent from the causal explanations. The ‘social’ in biopsychosocial in fact only features in terms of external ‘triggers’ or’ stressors.’ So, when it is claimed that the model accounts for the social world of the person, what is meant is that it acknowledges external pressures that contribute to otherwise biologically determined processes. The actual personal, meaning-pervaded social experiences we are all immersed in are, as such, irrelevant to the model, or at least without any causal efficacy. A ‘social cause’ within this model is simply a quantity of external force on the biological system, which is then where the disorder is located and expressed. While admitting a causal role to social factors is of course an improvement on the purely biomedical model, if that role is limited to a position in a causal chain that leads inexorably to biological processes, then we have not moved past the biomedical model in any meaningful way. We have just stretched it out a bit. While the biopsychosocial model is not pure biological reductionism or determinism, we are nevertheless talking about experiences that are only relevant in their effect on biological processes which then determine the ‘disorder.’ It is these processes that remain the focus — the main treatments (e.g. drugs, ECT) have remained the same — evidencing the supposed incorporation of the social world is nothing of the sort. The actual meaningful dimensions of our social experience remain absent from the explanations and, as result, from the primary interventions. The problem exists, as such, unchanged. The critical argument updated to reflect this change would assert that, without justification for doing so, (biopsychosocial) psychiatry still explains distressing emotional experiences biologically, by reducing non-biological events to quantities that only have ultimate relevance in terms of the biology of the person.
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