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Post by Admin on May 13, 2021 18:27:08 GMT
Karin Jervert: One thing has remained true for me as I’ve reflected on my journey into and out of the psychiatric system. My society—the education system, culture, economy and government that I existed within as a young woman—relied on me to internalize blame for all the ways it had failed me. The unfortunate, and often dangerous, “safety” net for the emotional repercussions of this toxic arrangement was psychiatry. It was psychiatry that then dug deep to nurture this seed of self-blame by planting the identity of the “mental patient.” Self-love, therefore, became for me a radical and revolutionary act of activism against this system. At its foundation was the rejection of “disease” as a label to define the uniqueness of my mind. Radical Acts of Community Healing and Self-Love www.madinamerica.com/2021/05/radical-acts-self-love/
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Post by Admin on May 15, 2021 0:31:44 GMT
E. Baden: Drowning in Doubts: Why I Think About Leaving Psychiatry After five years as an attending psychiatrist, I have seriously considered leaving the field. It makes me very sad, as I love to practice psychiatry in its truest sense. A practice where I consider the myriad of factors influencing the patient’s emotional state and prescribe very little medication. I am an extremely critical psychiatrist, but I do believe mental illness—although rare— does exist and that medications used selectively, conservatively, and for the shortest duration possible are beneficial. However, 90% of the people who enter my office are not mentally ill. They are having distressing emotional and psychological experiences. I would estimate 80% of these experiences are due to relational trauma, both current (abusive or unsatisfying relationships) and past (trauma inflicted by caretakers). These are very important problems; however, they are not medical problems and should not be medicalized. www.madinamerica.com/2021/05/drowning-doubts-why-i-think-about-leaving-psychiatry/I am an early-career psychiatrist and have been practicing adult, outpatient psychiatry as a part of a hospital-based mental health system in the U.S. for the past five years. I chose to pursue psychiatry because my favorite thing to do is listen to people. I am endlessly curious and interested in the human experience. I had a relative with schizophrenia who was shunned by his family and my heart went out to him and those struggling with similar experiences. I believed that as a sensitive, non-judgmental, and open-minded young woman, it would be an ideal career for me. I started questioning psychiatry in my third year of residency. I read an article on tardive dysphoria, or antidepressant-induced chronic depression, that intuitively made sense to me. It was just logical that leaving people on these medications indefinitely would cause a person’s system to oppose the drug. I did a presentation on the renal effects of long-term lithium use which horrified me. I was saddened to learn that so many would go on to live with long-term kidney damage after decades on the drug. I also began to understand the risks of antipsychotics and watched their use expand in a way that, again, horrified me. I saw these potent and extremely risky medications being used for everything from insomnia to anxiety to behavioral control. Clinicians were prescribing them without respect or restraint. Meanwhile, I became intensely interested in psychotherapy, which gave me hope and sustained me. This remains a joy to practice. However, no one is interested in hiring a psychiatrist to perform psychotherapy. I work in an underserved area, and as a concession they allow me to do a small amount of it to lure me to stay. I’ve come to see that employed positions are mainly interested in how much money you generate, which translates into seeing more patients than you can provide quality care for. After five years as an attending psychiatrist, I have seriously considered leaving the field. It makes me very sad, as I love to practice psychiatry in its truest sense. A practice where I consider the myriad of factors influencing the patient’s emotional state and prescribe very little medication. I am an extremely critical psychiatrist, but I do believe mental illness—although rare— does exist and that medications used selectively, conservatively, and for the shortest duration possible are beneficial. However, 90% of the people who enter my office are not mentally ill. They are having distressing emotional and psychological experiences. I would estimate 80% of these experiences are due to relational trauma, both current (abusive or unsatisfying relationships) and past (trauma inflicted by caretakers). These are very important problems; however, they are not medical problems and should not be medicalized. Yet patients come to me demanding that they be diagnosed with a psychiatric disorder and are sometimes very angry and offended if they are not. The majority tell me that they have “chronic depression and anxiety,” which they believe are due to faulty brain chemistry and will require medications for the rest of their lives. These patients have no other means to describe their distress than the words depression and anxiety. It’s very sad to see so many people suffering such profound disconnection from themselves due to the promotion of a false narrative. I imagine they grew up with a caretaker telling them that there was something wrong with them when they experienced negative emotion—most likely due to the caretaker’s emotional inadequacy— and now the medical system has retraumatized them with the same abuse. Patients are even more demanding of psychiatric medication, seeing me as someone to dole out prescriptions with no discussion. I have actually had patients tell me not to ask them any questions about the factors contributing to their distress, as that’s not my role, and to ask only about their symptoms. In the face of these issues, what has been exceedingly disappointing to me is the reaction of my colleagues. Psychologists and various types of psychotherapists who I anticipated would be like-minded allies have been anything but. I expected these practitioners to discourage medication and promote emotional healing. On the contrary, most of my referrals come from psychologists, who are diagnosing patients inappropriately with innumerable serious disorders including ADHD and Bipolar Disorder. Just the other day, I had a young woman referred to me by a therapist who had diagnosed her with Bipolar Disorder due to recurrent bouts of racing thoughts and feelings of overwhelm. The patient was a perfectionistic young woman fixated on the diagnosis and anticipating that a mood stabilizer would transform her into an idealized version of herself. I counseled her that she did not have Bipolar Disorder or any other mental illness and that difficult or unusual emotional experiences are normal. I encouraged self-acceptance and exploring contextual factors and ways of coping with her racing thoughts. She was unsatisfied, however, and told me she disagreed and would be seeking a second opinion. What was most troubling was that I had detailed the negative health effects of “mood stabilizers,” yet she remained unfazed. I have even had a therapist ask me to “blast” a patient with a mood stabilizer due to her frequent trips to the ED for anxiety. This patient was not only not bipolar but also, in my opinion, not mentally ill. In my experience, most therapists are not effective and are ego-driven, tending to interpret their own infectiveness as the patient’s need for medication. It’s all the more maddening, and absolutely frustrating because therapists aren’t implicated in the problems with psychiatry despite the intimate role they play in causing and perpetuating these problems. Primary-care doctors are generally very good people but, because of their training in the mind (or lack thereof), they prescribe psychotropics freely and inappropriately. In my experience, nurse practitioners are especially dangerous in this regard, particularly in prescribing stimulant medication. They will often message me complaining that a patient isn’t “better” and that I’m not prescribing to them adequately. These patients are often in abusive relationships but refuse to leave. I will not partake in numbing their natural distress, which will call them to leave the abuser. Medicine in general is creating so much sickness with overdiagnosis and overtreatment. No wonder our EDs and psychiatric hospitals are overwhelmed: We are creating “treatment resistant” patients at a rapid rate because they are not mentally ill. As there is no one in my field with whom I can discuss my feelings, I feel completely alone. When I started sharing these concerns during my residency, I was met with blank stares. I sometimes post about these issues on a forum for psychiatrists. A few participants will support me, but most will tell me I should simply get over it, pipe down, stop being dramatic, open my own private practice, etc. None of these suggestions will change our field and the damage it is doing to society. On the contrary, if someone posts about how much money they can make seeing the greatest number of patients possible, people are supportive— and no one calls them out on this extremely unethical practice. So I’m trying to find a way out. I will miss my patients dearly. A few do listen to me and reduce or discontinue medications and explore finding their way to emotional health and self-acceptance. Practicing psychiatry in a sane environment where I have ample time with each patient and no pressure to prescribe would be the ideal scenario, but sadly this is not the standard of care. I’ve read patient stories at Mad in America and I am so sorry for the mistreatment and abuse these people have endured. I see cases like those described fairly frequently. Sometimes I can help, but at other times, it’s too late. Going into psychiatry as a naïve 25-year-old, I had no idea what I would discover. If I knew then what I know now, I wouldn’t have chosen this field. At the same time, I’ve learned so much about myself and other people and have generally become a more conscious, whole person. I have become more understanding and accepting of my feelings and emotions and have learned to embrace instead of reject my emotional being. I have helped some along the way, but the trends in psychiatry are powerful and I feel as if I’m drowning as I try to swim against them. I’m not sure what my future holds, but until then I need to remain employed –which is why I have not attached my full name to this essay: I would certainly be fired. But as long as I’m still in psychiatry, I’m going to continue to fight the good fight. *** 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 May 16, 2021 19:00:45 GMT
Grassroots Activism: Rethinking Psychiatry Builds A Community A new Mad in America report by Amy Biancolli "Right from the start, the grassroots, volunteer-run group sought to welcome different perspectives — to empower them, not stifle them — in an effort to promote healing and reframe mental healthcare. No individual experience was considered valid or another invalid. No individual choice was considered right or another wrong." "Rachel Levy: 'We’re definitely not about telling you what treatment to pursue, or what decision to make, but we do want people to have accurate information — and we also want people to know that there are other options and alternatives.'" www.madinamerica.com/2021/05/building-community-rethinking-psychiatry/
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Post by Admin on May 19, 2021 17:11:30 GMT
Amid the push to identify biomarkers in psychiatry, psychiatrists Awais Aftab and Manu Sharma call for the field to pause and reflect on some of the problematic assumptions and contradictions that are often built into biomarker research. In their new paper, published in the Biomarkers in Neuropsychiatry, they lay out some conceptual considerations that can encourage a more thoughtful understanding of what biomarkers can really tell us about psychological distress. The article, titled “How not to think about biomarkers in psychiatry,” also warns against reductionist assumptions and approaches. Aftab and Sharma write: “We…examine some of the ways in which diagnostic biomarkers may prompt erroneous assumptions regarding etiology and reductionism, and we illustrate ways in which biomarkers can be approached in a more conceptually robust manner.” We Need Clear Thinking About Biomarkers in Psychiatry to Avoid Bioreductionism Philosophical psychiatrists caution against simplified views of biomarkers that reify psychiatric diagnoses and promote bioreductionism. www.madinamerica.com/2021/05/need-clear-thinking-biomarkers-psychiatry-avoid-bioreductionism/How not to think about biomarkers in psychiatry: Challenges and conceptual pitfalls www.sciencedirect.com/science/article/pii/S2666144621000022?via%3DihubIntroduction Throughout the centuries, scientists, philosophers, and physicians alike, have endeavored to identify and classify afflictions of human thought, emotions and behaviors. In fact, the ability to identify patterns of symptoms for the purposes of diagnosis and identification of appropriate treatment form a central tenet of medical sciences as a whole. Advances in medical sciences and technology have allowed us to create high resolution images of the whole body, and sequence the entire human genome, heralding the promise of personalized and precision medicine. Although the importance of biomarkers has been recognized across medical specialties for several decades now, biomarkers have assumed even greater prominence in research investigations pertaining to diagnosis and treatment in recent years, and psychiatry is no exception. A biomarker is, according to the FDA-NIH Biomarker Working Group, “A defined characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or biological responses to an exposure or intervention, including therapeutic interventions.”[14]. A quick keyword search on PubMed reveals that the number of papers published exploring biomarkers in psychiatry increased from about 229 papers in the year 2000 to 3617 papers in 2019. While this is partly reflective of the increased adoption and popularity of the specific term “biomarker”, it is also likely that this corresponds to an actual increase in the number of research studies investigating biomarkers for psychiatric disorders. As is evident from the FDA-NIH working group definition, biomarkers can be utilized for a wide variety of different goals and targets. Some examples include: • Susceptibility/risk biomarker: Reduced mismatch negativity (an early event related potential) has been associated with increased risk of transitioning to psychosis in individuals considered to be clinically at high risk for psychosis [5]. • Diagnostic biomarkers: PET scan using amyloid radiotracers such as Pittsburgh Compound B (Amyloid PET scans) have been used for the diagnosis of Alzheimer’s Disease [18]. • Monitoring biomarkers: MicroRNA based biomarkers have shown early promise in monitoring treatment response in depression [6]. • Prognostic biomarkers: Digital phenotyping has been used for predicting onset of mood episodes in individuals with major depressive disorder and bipolar disorder [10], [23]. • Response prediction biomarkers: Men diagnosed with Major Depressive Disorder with smaller N100 amplitude have been shown to be less likely to respond to Venlafaxine [13]. In this commentary we will focus primarily on diagnostic biomarkers, and we will discuss some of the inherent challenges associated with the identification of diagnostic biomarkers and some of the conceptual pitfalls regarding how we may interpret potential diagnostic biomarkers.
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Post by Admin on May 19, 2021 17:15:31 GMT
Around the Web, from Jody Chan/Midnight Sun: “before madness meant rage, it meant insanity. before that, a Latin verb: to change, to go, to move. anger comes from old English, meaning grief, sorrow, distress, affliction. before it was a word, anger bloomed around the rooms within us that needed protection. someone powerful became afraid of anger, and then it was given the same name as disease. madness is in my body. anger’s bubbling, burning, blossoming. it lives in each of us. a red lake. I tend to boil over. my heartbeat is a language of verbs, a late-summer reservoir of water. it threatens heat . . . — pre-verbal, as in before language or memory. a hardening in the eyes. a contraction of the chest. trauma can be held this way, but so can the way our ancestors fought for us. our bodies know things about freedom that our language cannot articulate. how to drop the shoulders. how to hold hands and chant in the face of an oncoming police line. how to centre in the spine . . . — the symptoms we pathologize as madness are so often strategies for survival, learned by our bodies, our ancestors’ bodies, over lifetimes of individual and collective trauma. my instinct is always to nod, to make small, to hold the breath, to scream on the inside only, to wield a smile, to optimize others’ happiness, to leave the frame. if feeling can’t get you what you need, why feel at all? . . . — in madness, I am more porous – no boundaries of time or space between my different hearts, between my body and the world. in madness, I have learned to be with pain, both my own and others’. I have ruptured from respectability. losing my name, losing the season, licking the telephone pole, entering myself with glass, sharp edges, a staple, shaking on a bench outside the fire station. we are not supposed to need like this. — madness can be a structure of possibility; it can force us to build bonds that outlast periods of crisis, political projects, the constrictions of capitalism. I don’t mean this as a metaphor. I trust the people I’ve crumbled with. every day, I’ve handed them my life. what it takes to stop paying rent. to refuse to go to work. what it takes to process conflict with tenderness. to learn in public. to daydream of your friends like you do your lovers. to commit to each other’s care, outside the grip of any institution. I am interested in the overlap between all of these practices. the trust they demand. the world they could lead us to. — certain modes of relating can crack us open, write Clémence x Clémentine. we are learning how to unleash our desires to the point that they rupture with capital. — it is not a moral duty to be happy. the bosses, the politicians, the landlords fear our collective unhappiness because it challenges the conditions that maintain their power. in that case, I would rather demand the abolition of violent institutions than be happy. I would rather be terrifying. — our protests, our organizations, our movements die when we disavow anger and grief as a source of their aliveness. what if we take madness as our centre?” Madness Is a Strategy www.madinamerica.com/2021/05/madness-is-a-strategy/
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Post by Admin on May 19, 2021 21:13:45 GMT
Ruby Urlocker: "The emotional blunting caused by antipsychotics is what has fueled, more than anything else, my sense that my treatment is immoral and inhumane." "Imagine the rest of your life being nothing more than a boring video game, a simulation of real life. One where you can’t feel truly emotionally invested on any satisfactory level... That’s what taking medication is like." "In that environment of the out-patient mental health clinic, professionals take note of anything except exclusive rationality; everything the least bit quirky or just authentic to a specific individual is viewed with skepticism, if not as a symptom." The Undervalued Potential of Living Without Psychiatric Drugs www.madinamerica.com/2021/05/potential-without-drugs/
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Post by Admin on May 20, 2021 17:57:12 GMT
Mental Health System: Open Letter to the Media www.madinamerica.com/2021/05/mental-health-system-open-letter-media/“We, a group of people with first-hand experience of the mental health system, write to express our concern about what we see as one-sided coverage of this system in the media and to draw the attention of civil rights organizations to the systemic discrimination that we witnessed and experienced. We, our loved ones, or inmates in the facilities where we worked, were exploited for monetary gain and victimized in various other ways. We saw how abuse, corruption, and exploitation were covered up, while victims and critics of the system were silenced and marginalized. EVERYONE WHO BELIEVES THAT THE PROBLEMATIC ASPECTS OF THE MENTAL HEALTH SYSTEM ARE NOT ADEQUATELY REPRESENTED IN THE MEDIA IS INVITED TO SIGN THIS LETTER. . . . Some of us had the rare fortune to encounter a psychiatrist who treated us or our loved ones with kindness, respect, and integrity; some of us saw patients who were helped, not harmed, by the mental health care they received. However, our experiences led us to believe that such cases are exceptions rather than the norm. We believe that the mental health services suffer from deep, systemic problems, and we want to draw public attention to them, to break the wall of silence, and to initiate a discussion as a step towards creating a humane and efficient system. WE INVITE THE MEDIA, CIVIL RIGHTS ORGANIZATIONS, SUPPORTERS AND CRITICS OF THE CURRENT PSYCHIATRIC SYSTEM, AND THE GENERAL PUBLIC TO DISCUSS THE FOLLOWING POINTS.” docs.google.com/forms/d/e/1FAIpQLSf37yXEAmaJl9Ejnacii9UH3PdPzHCEbOW7ZbRMgueaaO7i3A/viewform
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Post by Admin on May 20, 2021 18:00:59 GMT
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Post by Admin on May 20, 2021 18:02:40 GMT
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Post by Admin on May 20, 2021 18:09:10 GMT
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Post by Admin on May 21, 2021 19:28:03 GMT
In an article published in the Journal of Humanistic Psychology, clinical psychologist Alexandra Adame interviewed survivor-therapists, psychiatric survivors who work as psychotherapists and counselors to understand how their experiences shaped their approaches towards activism and psychotherapy in the mental health system. The findings suggest that participants managed their dual identities by finding ways of working that honored their experiences as psychiatric survivors and their training as therapists, all while interrogating our society’s attitudes and tolerance of madness. www.madinamerica.com/2021/05/psychiatric-survivors-therapists-negotiate-difficult-spaces-mental-health-activism/“There Needs to be a Place in Society for Madness”: The Psychiatric Survivor Movement and New Directions in Mental Health Care Abstract The psychiatric survivor movement is an international coalition of grassroots organizations that work for human rights in the mental health system. Previous research has examined how the survivor movement has critiqued and envisioned alternatives to traditional mental health services. The current study focused on a unique group of individuals who identify as both psychiatric survivors and work as therapists in the mental health system. I interviewed several people with this dual-identity to better understand their approaches toward activism and psychotherapy. This article focuses on one of the survivor-therapist’s experiences, and I explore the broader clinical implications for both survivors and mental health professionals and next steps for developing viable alternatives to the traditional system.
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Post by Admin on May 22, 2021 18:06:49 GMT
Paul Blackburn: The ERNI Declaration: Making Sense of Distress Without “Disease” The ERNI (Emotions aRe Not Illnesses) declaration is based on the idea that distress does not equate to disease, dysfunction, dysregulation, or chemical imbalance. Signatories believe that there needs to be a shift from illness and diagnosis ideas to personal narratives and understandings. The declaration was created with the appreciation that there are many like-minded people out there who share opinion, research, ideas, and experiences with others within many contexts but are frustrated by subsequent lack of action or change within mental health and other related systems. www.madinamerica.com/2021/05/erni-declaration/ERNI Declaration docs.google.com/forms/d/e/1FAIpQLSf_uYFmO4Jy33cARk9-f6QbM5inEBrmoCXHGcTSf2LpzhsrBQ/viewform
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Post by Admin on May 22, 2021 18:10:25 GMT
New work by Tarek Younis at Middlesex University reflects on the hurdles facing anti-racism efforts in mental health systems. Contrasting liberal with illiberal racism, Younis stresses the importance of macro-level policies and politics, using the UK’s Prevent policy as a case study of formally “colorblind” liberal racism in the mental health system. Structural racism in the mental health system has been documented in, for example, racial bias in the diagnostic process and injustices in the process and definition of recovery. Black people also make up a disproportionate percentage of the inpatient population in both the US and the UK. In general, Younis writes, communities of color are “at higher risk of mental illness and more likely to be impacted by social detriments; less likely to access mental health services and more likely to do so through crisis care; more likely to be medicated (rather than offered talk therapy) for mental ill-health, while external risk factors such as poverty and racism are overlooked.” “Colorblindness” and Liberal Racism in Mental Health A new article argues that “colorblindness” perpetuates racism within mental health institutions, from diagnosis to recovery. www.madinamerica.com/2021/05/colorblindness-liberal-racism-mental-health/The muddle of institutional racism in mental health onlinelibrary.wiley.com/doi/10.1111/1467-9566.13286
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Post by Admin on May 23, 2021 17:38:53 GMT
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Post by Admin on May 26, 2021 14:42:38 GMT
Hanna Pickard is a Bloomberg Distinguished Professor of Philosophy and Bioethics at Johns Hopkins University. She also worked for a decade at a specialist service in the NHS for people diagnosed with personality disorders and complex needs. Her work tends to address the sticky debates that arise in clinical practice. In this interview, she discusses her novel and possibly controversial "Responsibility Without Blame" model for understanding addiction, the numerous shortcomings of the neurobiological model, the importance of centering patient agency, and her work in therapeutic communities. Responsibility Without Blame in Therapeutic Communities: Interview with Philosopher Hanna Pickard By Ayurdhi Dhar, PhD -May 26, 2021 www.madinamerica.com/2021/05/bringing-responsibility-without-blame-mental-health-addiction-interview-philosopher-hanna-pickard/
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