Evolution Or Revolution?

On July 22, Just Another Word Press.com site ran an article called Evolution not revolution: My thoughts on the DCP’s call for a paradigm shiftThe website is owned and operated by MTAS Psychology, an agency providing psychological therapy and expert witness services in Manchester, UK.  The article is unsigned.

The primary focus of the article is the paradigm shift paper issued on May 13, 2013 by the British Psychological Society’s Division of Clinical Psychology.  That paper, as readers may remember, drew attention to “conceptual and empirical limitations” inherent in psychiatry’s so-called diagnostic system, and called for a paradigm shift – “towards a conceptual system not based on a ‘disease’ model.”

The author of the MTAS article expressed the belief that a paradigm shift of this sort is too extreme a step, and argues instead for an illness model that recognizes the importance of psychosocial factors.

. . . . . . . .

Here are some quotes, interspersed with my comments:

“I find myself in an almost constant state of conflicted ambivalence about this debate, most likely attributable to the unpleasant and unhelpful polarization that has taken place within the field in recent years…”

I view the polarization differently.  For the past forty years, I have argued consistently that psychiatry’s central tenets are spurious, and their core practices destructive and disempowering.  I have tried – and I know that others have tried – to engage psychiatrists in these discussions, but to no avail.  Psychiatry steadfastly ignored all conflicting views, and continued on their mission to medicalize (spuriously) every conceivable problem of thinking, feeling, and/or behaving.  For the past ten years or so, however, there has been a distinct turning of the tide.  What the MTAS author describes as unpleasant and unhelpful polarization is nothing more than psychiatry’s opposition finding its voice and – finally – being heard.  Some of the dialogue can at times be acrimonious, but the polarization in itself is neither unpleasant nor unhelpful.  Rather, it is long overdue, and for most of us on this side of the debate, is welcome.

. . . . . . . .

“Maybe it’s a lack of vision on my behalf, but I can’t envisage a mental health system that does not involve medication and forced hospitalisation for clients at their most confused and distressed.”

Perhaps it is the author’s lack of vision.  I have no difficulty whatsoever envisaging a system in which people struggling with problems of thinking, feeling, and/or behaving could go for help; where they would be listened to attentively and respectfully with no agenda of pigeon-holing them into spurious diagnostic categories; where  they would be seen as individuals operating within a context; and where the entire message would be:  you can!, rather than you’re broken,  you can’t.  Within my vision, psychiatrists have either ceased to exist as a profession or, more likely, operate in a shadowy world in which their activities would be seen for what they are – drug pushing.  Their activities would be divorced from the genuinely helpful activity mentioned earlier, for the simple reason that genuine care-givers will refuse to work with them.  Clients who wanted drugs would go to the psychiatrists; client who wanted help in finding genuine solutions to life’s problems would go to psychosocial helpers.

. . . . . . . .

“I think a symptom/experience based focus could further our understanding of certain presentations, particularly when we remember that a proportion of people satisfying the criteria for a diagnostic category will not represent the archetype, and will sometimes have quite divergent experiences from one another.”

There is no archetype.  And the people embraced by any psychiatric “diagnosis” will always have gotten to the point they are by different routes, and they will always have very different experiences.  This is the essence of the matter.  Psychiatry’s so-called diagnostic system does indeed imply archetypes, but it’s all a fabrication.  Psychiatrists “see” these archetypes because they invented them, and they have become the distorting lens through which they view their clients.  The archetypes have no ontological reality.

. . . . . . . .

“…any symptom/experience based approach to research would have to include some system for organising participants into meaningful groups.”

This statement is simply false.  Much, perhaps most, research done in the behavior therapy/behavioral analysis field, for instance, is of the before-after, single-case design, where the object of the endeavor is to understand the dynamics of the situation, and to develop appropriate interventions.  Psychiatrists, by contrast, routinely pretend (or perhaps have even convinced themselves) that they achieve understanding of a client’s perspective by assigning him a label.  Consider the hypothetical conversation:

Client:  Why am I so depressed?
Psychiatrist:  Because you have an illness called major depression.
Client:  How do you know that I have this illness.
Psychiatrist:  Because you are so depressed.

This is the essence of psychiatric diagnosis:  a futile exercise in circular reasoning, whose only purpose is the justification of a prescription for psychotropic drugs.  The use of these spurious categories in psychiatric research is not only unnecessary, but actually introduces a huge measure of invalidity into the results.

. . . . . . . .

“Lumping all of these people together could be problematic for conducting reliable research, but separating them up is, essentially, just another way of categorising people.”

Research that uses unreliable grouping criteria, not only could be problematic, it is problematic.  And generalizing from such research is also problematic, but sadly is the norm in psychiatry.

Separating people up (i.e. treating them as individuals) is not just another way of categorizing people.  In fact, it is the opposite of categorizing people.

. . . . . . . .

“I just can’t conceptualise how one might start to meaningfully organise clients’ difficulties without using categories or groups.”

 I think there are a number of problems here.  Firstly, I don’t believe that most clients want, or need, to have their difficulties organized.  I can accept that a small minority of clients are confused and might appreciate some assistance with organizing matters, but, in my experience, the great majority of clients are able to express and explain their problem(s) clearly and unambiguously.  Secondly, and, more importantly, even if a person does need help organizing his difficulties, slotting these difficulties into arbitrarily defined and unreliable pigeon-holes is unlikely to be helpful, and is more likely to be seen as patronizing and condescending.  If a client states that he worries a great deal about all sorts of things, what possible value is provided by my telling him that he “has” generalized anxiety disorder?

. . . . . . . .

“In saying all of this, DSM 5 was an omni-shambles and there is surely a more scientifically sound way of organising the presenting problems of service-users. I am all for developing new, more robust systems, but calling for a wholesale ‘paradigm shift’, when a workable alternative has not yet been developed, never mind validated, is a bit of a misstep in my opinion.”

But there is a working alternative:  listen to what the client says; ask clarificatory questions as needed; listen to the client’s responses; discuss; help the client mobilize his strengths to alleviate his difficulties; coach; support, etc., as needed.  But above all, listen respectfully.  This is not the medical model, but it’s what’s needed.

Besides, what possible use can there be in categorizing people’s presenting problems with a framework that the author acknowledges is an “omni-shambles”?  The development of  “…a more scientifically sound way of organizing the presenting problems of service users…” has been psychiatry’s stated goal for six decades.  But in this regard, DSM-5 is no better than DSM-I (1952); and in many respects is a great deal worse!  Perhaps it’s time to acknowledge that people’s problems of thinking, feeling, and/or behaving are too individualized and too context-specific, to lend themselves to any kind of simplistic, pseudo-medical categorization.  Perhaps it’s time to acknowledge that slotting people and their problems into categories, whilst perhaps conferring some sense of control and efficacy to the practitioner, affords no benefit, and a good deal of harm, to the client.

. . . . . . . .

“I really don’t see why the two approaches must be mutually exclusive.  One of the therapy models I practice is Interpersonal Psychotherapy (IPT).  It takes the approach that depression is an illness.”

The word “illness” means a functional or structural pathology within the organism.  Depression is not an illness, and any attempt to treat it as such is deceptive, unhelpful, and ultimately disempowering.

And the two approaches must indeed be mutually exclusive, because treating depression as an illness is simply incompatible with treating depression as the normal human response to loss, other adverse events, or a meaningless, treadmill kind of existence.

. . . . . . . .

“Personally I despise the name BPD [borderline personality disorder], but, at the same time, certainly see the value in having a group or category that captures the kind of difficulties often experienced by this group of clients.”

The author is missing the point.  A spurious category by another name is still a spurious category.  Even groups that reflect very simple categorization criteria are extremely heterogeneous.  The eleven members on a soccer team could all be categorized as soccer players, but their outlook and motivation will inevitably differ enormously.  One person may be there for exercise; another to please his parents; another to aggravate his parents; another to show off to his girlfriend; etc…  For some, soccer is a lifelong passion, for others a passing whim.  How much more divergence will there be with DSM’s intrinsically unreliable criteria for the condition labeled borderline personality disorder, e.g.:

1.  Frantic efforts to avoid real or imagined abandonment.

At what point does an effort become a frantic effort?  No distinction is made between efforts that involve sending lots of emails, for instance, vs. kidnapping and physical confinement.  How do we assess “imagined” abandonment?, etc…

2.  A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

How do we define relationship instability – two break-ups in a year?  Three?  Five?  How do we define, or even begin to measure, the intensity of a relationship?  And “alternating extremes of idealization and devaluation” – how do we distinguish this from the ebbs and flows of “normal” relationships?  Does anyone seriously imagine that a criterion worded in this way is capable of consistent application?

3.  Identity disturbance: markedly and persistently unstable self-image or sense of self.

What does “identity disturbance” mean?  Doesn’t everyone’s self-image fluctuate and change over time?  How do we assess “markedly” and “persistently”?  And what in the world is “sense of self”?  And DSM-5 is not helpful:  “Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all.”

And so on for the other six criteria.

And remember, even if we manage to make any headway with the individual criteria, the “diagnosis” is considered positive if five or more of the nine criteria are met.  From high school math we know that there are 256 ways to select five or more items from nine.  So “borderline personality disorder” subsumes at least that number of specific presentations.

. . . . . . . .

“…as psychologists I think we use categories all the time.”

I would say:  as psychologists we understand, or at least ought to understand, the conceptual limitations of categorizing people, or people’s thoughts, feelings, or behavior.  We also recognize the damage done by “diagnostic” categories in terms of stigmatization and reduced expectations, and we generally confine our interest and our attention to specific behaviors that can be reliably identified and discussed meaningfully.

. . . . . . . .

“Whilst I share some of my colleagues’ concerns regarding the relative dominance of a medical model for understanding human suffering, I think both can exist together, at the same time.”

To which I can only respond that the past 60 years of psychiatric hegemony suggests otherwise.  During this time, psychiatry has relentlessly promoted its spurious medicalization of all forms of human distress and has routinely marginalized and even ridiculed its critics.  It has developed a system that is simply incompatible with the conceptual framework employed by the great majority of social workers, counselors, psychologists, job coaches, etc…  Here in the US, childhood temper tantrums are now a mental illness, and we have toddlers as young as two years old being prescribed neuroleptic drugs!  What room is there in such a system for a context-sensitive, psychosocial approach?

. . . . . . . .

“A combination of perspectives is always favourable, surely?”

Compromise, and a combination of perspectives, are sometimes favorable.   Other times – as in the present matter – they are not.  Surely!  What kind of theory of fire would chemists have today, for instance, if the oxygenation proponents had compromised with the phlogiston theory adherents?  Some conceptual frameworks are just plain wrong, and need to be scrapped.  Psychiatry has been intellectually bankrupt for most of its history, particularly for the past fifty years.  At the present time it is being maintained on life-support by pharma money.

CONCLUSION

For the past ten or fifteen years valid criticisms have been directed at psychiatry’s “diagnostic” system, and at its range of treatments.  Psychiatry has not only ignored these criticisms, but has actually accelerated its medicalization agenda, and has asserted the putative efficacy of its treatments with increased vigor.  There has been no slowing down of the psychiatric juggernaut, and apart from the efforts of a small number of psychiatrists, there has been no indication that basic concepts or practices are being reconsidered, or re-evaluated in any way.

The human toll, in terms of ongoing damage, disempowerment, and stigmatization, is enormous, and continues to grow.

There is, in my view, no possibility that a system led by psychiatrists will ever become truly helpful in the alleviation of problems of thinking, feeling, and/or behaving.  There is an urgent need for a paradigm shift, and the BPS’s clinical division is to be commended for taking this initiative.  There is an urgent need to develop an alternative system, based, not on the notion that people are broken and need chemical adjustment, but rather on the notion that, with help, people can resolve their problems and find some peace and contentment.  The notion that such a system can develop and thrive under a psychiatric roof is simply unrealistic.

  • barry

    I’ve read that blog too (mtapsychology) but I don’t agree with not using drugs, not that im a qualified professional.
    I see this blog above about:
    1) power/authority and it’s exercise
    2) legitimacy
    3) effects

    Sometimes I think that breaking power down might help logically resolving problems.
    Are people against the use of drugs (‘meds’) because:
    1) it is given with accompanying denigration and nasty attitudes? I have seen this all the time in some units.
    2) the drugs help but you disagree with authoritarianism.
    3) the drugs don’t work?

    To me, 1 and 2 are real and understandable, but 3 is less so. I think you see power in everything, which is a flaw in your view. I just get the feeling that if a psychiatrist liked your favorite peice of music, you would then have to hate it. I think you are over identifying with power.
    But, when it comes to classification, I think you have some valid points. At rock bottom social prejudice does appear in some classifications, passed off as objective observation. True also that diagnosis is overly reductive, and that power manipulates through the rituals of diagnosis, the doctor behaving like a snake trying to hypnotize a rabbit…..:)

  • Neo

    John Lennon was not just a great lyricists, he was also an incredible visionary. But if John were here today he would humbly confess to the truth. It was all an inside job. He did much of his writing automatically . . . while accessing the wisdom of the collective. We all have the potential. Clearing one’s mind of all gunk is the hard part. John was about as close to being gunk free as humanly possible.

    If hero worshiping must be done, in my mind there can be no greater hero to humanity than this ordinary Joe from working class Liverpool.

    It is time. Winning is easy. Wake up and wake up those around you. Waking up means ridding oneself of the forces of dissociation and cognitive dissonance that blind us to our true reality. We are slaves to a social structure designed for automatons by Tavistock.

    http://youtu.be/AqC_Gma221M

  • Jorge_Videla

    “But there is a working alternative…”

    Yes, but…

    then where’s the science or profession? Why a PhD? Why an MD?

    Just like transsubstantation is “necessary” to the Roman priesthood. Just like every new law is a bill for the full employment of lawyers.

  • Phil_Hickey

    Jorge,

    Good point. People are very jealous of their credentials, and you’ll get a lot of different takes on this issue.

    Here’s mine: In college, one can acquire some general concepts for understanding human thoughts, feelings, and behavior, including one’s own. However, I don’t think one can learn how to “do therapy” except with regards to some very general ideas. But it’s the application of these ideas to the specifics that is critical, and that has to be based on an ability to set one’s own agenda aside and just listen.

    People with no formal credentials are sometimes extraordinarily skilful in this area, but that’s heresy!

  • Neo

    “set one’s own agenda aside and just listen.” The ghost of C.G. Jung comes screaming through your broadband connection to the collective. Not really since in your case that thought would be already sitting on your local drive. But do see the great thoughts which at times come from those who who lack the foundation for them as if they just somehow pulled them out of the aether. I don’t know if everyone can appreciate it but I can at times see the connection between the mind and the collective+

  • cannotsay

    Outstanding, as always. I want to add some interesting thoughts to the point about the author’s lack of vision. Just today, in a comment still pending moderation, I addressed the same topic with Joel Hassman. Below his question and my answer!

    “you are an abolitionist, and you have no idea what to do should you succeed in eradicating the role of psychiatry for society”

    While it doesn’t exactly address the question, the differences in involuntary commitment standards between Europe and the United States allow us to at least imagine how a future without coercive psychiatry would look like.

    Since I am a bit egocentric, as you have probably noticed, I will start with my own case but I will conclude with a more general thought. I am the same person here as in Europe. Here in the US, because the standard for involuntary commitment is such that I cannot be committed unless I am a danger to myself or others, I can lead a highly productive life, on the economic side, fearless that going to the doctor might mean that I could lose my freedom. I stopped all psychiatric drugs several years ago, so I do not suffer from the side effects of using SSRIs and clomipramine long term -which I am sure you know already. I do not live under “surveillance” by the medical establishment, free to do what I please, except for a set of activities that I am legally precluded from, like working in positions that require security clearance, because of me having been involuntarily committed. Other than that, I go by my business and my OCD-ish quirks do not bother anyone with the possible exception of people like you who engage with me in the debates that need to put up with the “O” 🙂 .

    In Europe, I was told that I was involuntarily committed because I was destined to become homeless, probably in less than one year (I am not making this up). This, despite the fact that when my commitment happened I was working here in the US in a high paying job and the single most important impact on my life was that I could have lost that job. In other words, to justify an assault on my civil liberties they had to make up a “need for treatment” excuse so that the commitment order could go through. Had I decided to stop the drugs over there, as I did here, I would have been sent back to the psych ward to force me on the drugs and I would have been on permanent “medical supervision” to make sure I was compliant with the drugs. During the time I was forced to stay in Europe, my ex family members were told by the psychiatrist who committed me that they should call the equivalent to 911 if I ever decided not to collaborate with the so called “treatment plan”.

    So in my case, this is not an academic exercise. It is comparing the life that I lead here in the US, where I can voluntarily keep psychiatry out of my life, with the life that I would have in Europe where I could NOT keep psychiatry out of my life voluntarily.

    So this is the general thought. We know from experience that there are millions of people here in the United States who live very productive lives all while being able to say NO to psychiatric drugging. Their quirks or eccentricities do not send them to psych wards as they did prior to http://en.wikipedia.org/wiki/O%27Connor_v._Donaldson . Because of America’s own past experience and the current European experience we know that many of these people’s lives would be crushed by institutional psychiatry if the standard for civil commitment were to be lowered. So the proposal is simple: just as having a lower standard for civil commitment liberates people here vs what happens in Europe, I propose to liberate everyone and empower them with individual freedom to do what they please just as I do as I please and I would not be able to do as I please in Europe. And then, those who misbehave should suffer the consequences of the criminal justice system.

    People are naturally afraid of the unknown. My own case, and that of millions of other Americans, is proof that the concern of European psychiatrists that people like me cannot live unsupervised and without drugs is invalid. Similarly, just because you, and many in your profession, cannot conceive a world in which coercive psychiatry doesn’t exist, it doesn’t mean that it is not possible or that you have a valid concern. It just means that your own fears make you unable to conceive such a world. This is why I draw parallels between the do gooders that opposed slavery and those do gooders that oppose the abolition of coercive psychiatry. The main obstacle for a world without coercive psychiatry is their own fears and their belief in government paternalism.

  • Nanu Grewal

    Hi Phil,

    I know that the last thing the world needs is another medical acronym…however, with respect to your comments about the line: “but I can’t envisage a mental health system that does not involve medication and forced hospitalisation”, I have given a lot of thought to the un-diagnosis of the millions around the Western world with labels from DSM, and have come up with PSICHOL

    And this stands for:
    People Struggling In Coping with the Happenstances Of Life.

    In my clinical practice (and as I have discussed with you, I am not QUITE in agreement with you that there is absolutely no primary mental illness – but my stance is that it is very, very rare), the vast majority of people with DSM labels, in my envisaged post-Modern-Psychiatry world can be re-designated PSICHOL and helped accordingly. Plus they most DEFINITELY will not need medication or forced hospitalisation (outside of pure totalitarian political-control systems)

  • Anonymous

    “Here in the US, because the standard for involuntary commitment is such
    that I cannot be committed unless I am a danger to myself or others”

    That’s not objectively true. A more correct way to put it would be that you don’t face forced psychiatry in many parts of America unless you’re labeled a “danger” by a government psychiatrist. It could still happen. I think you are completely right to live in fear of forced psychiatry, but I don’t think if you were simply “living in Europe” you’d have this come down on you again, I think it is more the case that contact with your family in Europe, combined with living in Europe, is the main predictor of you being in European forced psychiatry. I believe it would be possible, quite possible, for you to live in Europe and have no contact with your psychiatry true believer family, and still be at liberty. Don’t overplay the U.S’s freedoms either, yes, it’s the freest developed nation on Earth, but there are people with psychiatric labels in many states, facing home based forced drugging (“community commitment”) simply because the legal standard for that is “has been hospitalized such and such many times in the last few years” and a psychiatrist says this is “due to noncompliance with” the drugs they call “medication”.

    There is a 12 year old girl being forcibly drugged in Wisconsin right now, labeled unfit to stand trial in a stabbing case. There are countless people at any given moment screaming out in terror as they are taken down to the floor by staff and stabbed with syringes in ERs all over the US under the auspices of so called “emergency psychiatry powers”, I know you desire security and you’ve probably got, depending on what state you chose to settle in, more security than in Europe, and you’re old enough and wise enough not to make the wrong moves.

    I have no idea why you’d waste your time trying to argue with this Hassman cult member, but suit yourself. America has many of its citizens owned by forced psychiatry, psychiatry’s slaves, and it stands to have many more as freedom continues to fall away.

  • Anonymous

    Thank you for not supporting forced drugging. Nice outlook. And it’s very good that you admit that forced psychiatry is totalitarian. Survivors of forced psychiatry, are survivors of pure totalitarianism, yes, hiding in plain sight in your peaceful Western world developed country where most people mistakenly think totalitarianism lives overseas. Weaved into every peaceful tree lined street in Canada, United States, UK, Australia, New Zealand, Germany, Ireland, France, Italy, etc etc, are survivors of the most pure totalitarian hell, survivors of brain rape. They deserve respect, deference, and a release from their pain and life sentence of living in fear. Refugees to the West subjected to Western forced psychiatry often wish to flee back to where they came from. Forced drugging has no right to exist in a free society, is unjustifiable, and its supporters and proponents and justifiers don’t see those assaulted by it as fully human.

  • cannotsay

    Actually that is objectively true. The matter of under which circumstances a person can be involuntarily committed has been reviewed by the highest courts on both sides of the Atlantic. These courts have reached diametrically opposed conclusions,

    – United States Supreme Court: involuntary commitment is a deprivation of liberty, therefore it cannot be done unless the person is dangerous. Quoting from that decision “mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty. In short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends” . This standard, known as Connor v Donaldson (1975) , forced states to change their civil commitment laws and had a measurable impact on the involuntary commitment rates nationwide. It went from around 200 per 100000 to around 10-20 per 100000 we have currently. Very imporantly, once people were able to get out of their involuntary commitment, many psychiatric hospitals were forced to close. These closures provided a real barrier to massive committals.

    – European Court of Human Rights. While there isn’t a single, precedent setting decision, an analysis of decisions made prior to 2004 on the matter has provided legal support to the notion that “involuntary commitment” is a therapeutic measure and that psychiatrists know best http://egov.ufsc.br/portal/sites/default/files/anexos/33124-41808-1-PB.pdf

    “Article 5 is the article quoted most often in the applications
    concerning psychiatric commitment. Paragraph 5-1(e) clarifies
    that the lawful detention of a ‘‘person of unsound mind’’ constitutes a legally valid exception to the general principle of the right
    to freedom of an individual. This exception thus rests on two definitions: ‘‘unsoundness of mind’’ and ‘‘lawfulness of detention’”

    “The Court considers any determination of ‘‘unsoundness of mind’’ to be valid as long as it is made by a psychiatrist, and does not take into consideration the degree of affiliation of the psychiatrist with the State”

    “The case Herczegfalvy v. Austria (10533/83) is characteristic of the Court’s difficulty in analysing the validity of medical
    treatment. The applicant, who had been on a hunger strike,
    was force-fed and given strong doses of neuroleptics. He
    was also placed in seclusion, restrained with handcuffs, and
    secured to a bed for several weeks on end. The Court criticized
    the lengthy duration of the seclusion and the immobilization,
    but accepted the argument of the Austrian government that
    this type of treatment was justified for therapeutic reasons,and thus could not be considered as inhuman and degrading”

    “As for the appropriateness of the medical treatment provided, various cases such Grare v. France (18835/91) or Warren v. United Kingdom (36982/97) show that the ECHR always trusts the psychiatric medical evaluation, as far as it satisfies the criteria of usual practice”

    This explains why the involuntary commitment rates in most Western European countries are like 10 times higher than here in the United States, anecdotal cases aside.

    God bless the USA!!!

  • Phil_Hickey

    Barry,

    I’ve never said that people shouldn’t use drugs. In several posts, e.g. here, I’ve stated clearly that it is a decision for each individual. What I do object to, however, is psychiatrists pushing these drugs under the pretense that they are medications to treat an illness, which is simply not true.

    I’m not sure where you’re picking up the power issues. My complaints about psychiatry are that their concepts are spurious and their “treatments” harmful and disempowering. I would object to this whether they came across as rabidly authoritarian, or meek conciliationists. It’s what they do that’s reprehensible – not how they do it.

    With regards to the drugs working or not working: in the short term they often provide a temporary emotional lift. In the long term they always do damage. I listed some of these damaging consequences in the post.

    With regards to classification – or “diagnosis” as psychiatrists like to call it, I’m sure you’re right that at times there is some measure of social prejudice involved. But for me, that’s not the primary issue. The primary issue is that one simply can’t classify the vast range of human presentation with a few simplistic, ill-defined categories. Human beings are always so much more complex than psychiatry’s crippled caricatures.

    Again, thanks for coming in. I’m not entirely sure that I’ve responded to your points, so please feel free to come back. I welcome dialogue.

    Best wishes.

  • Phil_Hickey

    cannotsay,

    Thanks for this legal background – very helpful!

  • Phil_Hickey

    Nanu,

    Thanks for coming in. PSICHOL is nice. There’s a lotof it about!

  • cannotsay

    You are welcome!

    I spent some time analyzing the matter after my commitment (it happened in Europe and it lasted more than what is even the standard in my former country as to make sure that I was brainwashed enough to remain “compliant” upon my return to the US). I was literally told that much in my face, that they knew I could not have been committed in the US and that they needed to assure themselves that I would continue the so called “treatment” before they would let me go.

    Article 5 of the European convention on Human Rights, mentioned above, contains an explicit exception to the right to liberty in the case of https://en.wikipedia.org/wiki/Article_5_of_the_European_Convention_on_Human_Rights

    “e. the lawful detention of persons for the prevention of the spreading of infectious diseases, of persons of unsound mind, alcoholics or drug addicts or vagrants;”

    So obviously, this different standard has real life consequences. According to the ECHR the basic principle of the therapeutic value of involuntary commitment is not even in question, only the actual meaning of “lawful” and “unsound mind”. This means that when somebody is involuntarily committed his/her rights are not deemed violated. On the other hand, the US Supreme Court has repeatedly said that any deprivation of liberty for psychiatric reasons is a violation of a fundamental right and that it cannot be done unless a set of very strict tests are applied, including that there is no less restrictive alternative available.

    The case mentioned by Anonymous is about a criminal defendant whose guilt is not in question. If anything, I think that the travesty is the whole notion of “incompetency to stand trial”. She should have been tried, found guilty and sent to jail for the maximum time permitted by law. I have no sympathy for people who violate criminal laws, particularly when said violation involves hurting other people.

  • Anonymous

    Courts don’t mean much when you can be arrested, dragged to an ER, held down by goons and shot up with drugs, at a moment’s notice, all over the US. Maybe for longer term commitments courts matter, but they sure don’t protect you from being assaulted in this way. So when the US Supreme Court, which said slavery was OK for the first few decades of its existence by the way, says, “- United States Supreme Court: involuntary commitment is a deprivation
    of liberty, therefore it cannot be done unless the person is dangerous.”… I don’t place much stock in that, that’s just the government SAYING someone is “dangerous”, and we all know that is usually just a psychiatrist claiming someone is “dangerous”, and that psychiatrists are not better than a coin toss at predicting future behavior, and that a judge will defer to psychiatric “expertise” 90 percent of the time. I am glad you feel safer in the USA, but I maintain that if you had a family in the USA that believed in forcing psychiatry on their “loved ones”, and were in fact undergoing an extremely distressing and overwhelming state of mind in your life, a crisis, the US Supreme Court will not save you from the terror you have feared your whole life. You are safer (from long term commitments only), because of the legal standard, but mostly safer because your family, that believes in forcing psychiatry on people, is an ocean away. And you have stated in the past that you disowned your family and refused to speak to them ever again after they forced psychiatry on you, I think this sends a clear message to families how serious this issue is, my family knows that I would never speak to them again if they unleashed the forces of forced psychiatry on me in the future. There can be no toleration. And do not forget, that in many states of the US, there’s people being forcibly drugged long term, in their own homes, 24/7, under Laura’s Law type arrangements, and the legal standard for that is not simply a psychiatry backed accusation of “dangerousness”, it has “been hospitalized X many times in X number of years due to noncompliance”…

    If the US really was a place where you had nothing to fear unless you really were a “dangerous person”, then peaceful, non-criminal citizens labeled “mentally ill” would not be on court orders to receive forced drugging injections weekly or biweekly or whatever, would they? NYPD, as collective punishment against an entire group of innocent people labeled “mentally ill”, rounds up people because of someone else’s crimes…

    https://www.youtube.com/watch?v=Lg468Wjk4AI

  • cannotsay

    Anonymous,

    Several points:

    – First I must correct you that the US Supreme Court had no say whatsoever on slavery being legal or illegal. Slavery was legal, in those states that allowed it, when the US constitution was enacted in 1787 and became illegal nationwide in 1865 when the 13-th amendment was enacted. I think you are getting confused with “separate but equal”, explained here https://en.wikipedia.org/wiki/Separate_but_equal , which is a doctrine that legalized racist laws in the United States, but not slavery, for decades until it was repealed in 1954 by the US Supreme Court.

    – Second, I am not discounting the pernicious effects of families. As you said, I disowned my own for what they did and my only regret is not having done it sooner :). In retrospect my commitment was the culmination of the disdain they had for me since, well, as far as I can remember. In a way, I am lucky that at least when they crossed the point of no return, I was already an adult. Imagine these hateful people having done what they did to me when I was, say, 15. It is so horrible that I prefer not to think about it :). My point is that the legal framework still matters. In fact, the largest group backing the infamous Murphy bill are family members. Right now, in the US, even if your family member calls the police and makes up stuff that you are dangerous to have you committed, something called HIPAA
    https://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act prevents them from knowing whether you were committed in the first place if you tell your doctors not to tell your family. One of the provisions of the Murphy bill changes this. Also, these hateful families backing the Murphy bill complain how difficult is to get their “alleged” loved ones into so called “treatment”. Finally, as long as you are deemed in possession of legal capacity, which you are after 18 by default unless your family goes through a lengthy legal process of declaring you legally incapacitated which places on the family a very high burden, it is very easy to disappear legally from one’s family’s view. Although not explicitly endorsed, the US system assumes the right to “be left alone” as one of the most fundamental rights of citizenship. Many American survivors who have problems with their families make the mistake of keeping in touch with their families, giving these families ammunition to abuse them by letting these families make up stuff. I have absolutely not pity for these survivors, frankly. Once I understood that just putting my feet in my former country would put me at risk of being civilly committed again, I have not been back. I strongly believe in the old saying “fool me once, shame on you, fool me twice, shame on me”. Those who let themselves be fooled twice, well, shame on them!

    – Third. I don’t know how it is in Australia, but in Europe, one of the side effects of nationalized medicine is that there are all sorts of databases with your medical info that can be accessed nationwide by “medical professionals” and, in some cases, EU wide. So, once you have a “mental health record”, it is impossible to get rid of it for good. In the US, you can restrict access to it to the doctors of the facility where the medical record exist. In fact, although recent legislation has created so called Health Information Exchanges to allow patient data to be shared between facilities, participation in these exchanges is voluntary and you can opt out of it, which I have. So the current doctors that I have to follow up with my kidney and liver, have absolutely no clue that I have a mental health record somewhere else. Further, if they were to behave in a cocky manner and attempt to figure out that I have one in violation of my wished, I could sue them for violating privacy laws, so they won’t do it. Recently,on a different matter, the NY Times had a piece on the different attitude/legal powers of French doctors, which you can extrapolate to European doctors, and American doctors http://www.nytimes.com/2014/08/01/world/europe/french-families-challenge-doctors-on-wrenching-end-of-life-decisions-medicalized-hospital-deaths.html

    “Doctors in France have long held what, by American standards, might seem unthinkable discretion to make end-of-life choices for people in their care.

    For patients unable to communicate, such decisions fall legally to the physician, who may withdraw treatment or administer care that will end a patient’s life so long as the stated intent is to relieve that patient’s suffering, and not to kill. The opinions of family members and fellow doctors must be heard, the law states, but by no means obeyed.

    That physicians wield such expansive powers is a peculiarity born of France’s paternalistic bent, of a culture of deference to hierarchy and expertise, doctors and social scientists say.”

    – Fourth. As judge Napolitano explains -in full disclosure I am a huge fun of his- the US is pretty clear that pre crime policies are illegal under the US constitution and that unless you are deemed an immediate danger to self or others, you cannot be locked up for psychiatric reasons. While different states apply this standard differently, the reality is that the protections he speaks of are real, even though the NYPD might try to circumvent them. The NYPD is notorious for trying to circumvent civil rights on other areas, https://en.wikipedia.org/wiki/New_York_City_Police_Department_corruption_and_misconduct , so it is not surprising they would try to do this in the case of Kendra’s Law, which is NYC’s version of AOT.

    Anonymous, I am a huge fan of yours, but on this matter, you are simply wrong. As I said, the rates of involuntary commitment and the numbers about the people on AOT tell the story. Many states who have AOT laws do not implement them because they are too cumbersome.

    You can bring all anecdotal cases you want, but I rather live in any state of the United States than in any other Western country, psychiatry wise. However abusive the US’ most abusive mental health laws are, they are still less abusive than anything that exists in Europe, and from what I gather, in Canada, Australia or New Zealand.

  • Anonymous

    I have always agreed that the US is the freest country in the western world. I have said that, and I agree that in regards to forced psychiatry, it is a hard place to have psychiatry forced on you medium or long term. I don’t believe it is hard to have short term forced drugging forced on you, under the “emergency” powers of forced psychiatry laws in America. Thanks for the comment, and it was a good comment, very good. I’m glad you liked the Judge’s video, I like the Judge too.

  • Neo

    A great place to set up a really good world class conspiracy, too.

    There is no need to fear, Underdog and friends are near. This is going to be educational and entertaining. But, first we need the rest of the world, especially those in psychiatry, to commit . . . commit to me being a delusional conspiracy theorist nut. So, by all means let’s make an APA Mind Game of this and have all the psych residents in training join in to help me with my diagnosis.

    Another wise guy friend of mine. A seeming chance encounter back in 2004. Spent sometime in the William Menninger Dream Lab did we Dr. May? Small world, huh? Another coincidence supporting my delusions. LOL

    Edwin May, Phd., Nuclear Physicists, Parapsychologist, Comedian, and Co-conspirator Extraordinaire.

  • barry

    Thanks for replying. I am new to this debating malarky and am still forming my ideas! If I understand correctly, the position is that psychiatric diagnosis were invented with the advent of disciplinary society, round about the time of the Enlightenment. This was explored by Michel Foucault in Discipline and Punish, Madness and Civilisation (ironic title!) And other works. These were taken up by R D Laing.
    Because these diagnosies have no histology, that the tissues show no change, then they aren’t true illnesses.
    Interrupted by dinner. Post again later!

  • barry

    Cont.
    Obviously people can think they know more than they actually do when these diagnosies are thrown around in the public sphere, and, unfortunately, in services. Of course, no system of categories can ever do justice to the rich diversity of human beings, and any attempt to categorize experience will remain perverted to its aims.
    I have noted that the anti psychiatry movement has a romantic narrative element of the oppressed service user against the beastly system. True no doubt, but being too emotive can marginalise other service users, particularly men. There isn’t a male equivalent of Ophelia! Also, the service user movement must be mindful not to be motivated by revenge, and treat other service users as pawns to be sacrificed in order to achieve an outcome, such as not prescribing drugs, which some seem to advocate.
    Best wishes.

  • Cledwyn Bastardo

    Too extreme a step? Why couldn’t he have just said, “based on current cirumstances, because of the alliance of vested interests arrayed against a paradigm shift, it’s not likely.”?

    This stigmatization of radical change was once satirized in the comedy Blackadder Third, set in the 18th century, where the interviewer at a general election, in response to the leader of the “Standing at the back dressed stupidily and looking stupid party”, Ivor Biggun’s summarization of the party’s main policies, says,

    “Any reasonable person can sympathize with with your position regarding the compulsory serving of asparagus at breakfast, but what about this extremist nonsense about the abolition of slavery.”

    Too extreme for who? For those controlling and profiting from the the system.

    When people start labelling your position “extreme” and “dangerous”, be they people. like the average man, with a status qua bias rooted in a hostility to change per se, or the hostility of one who has a stake in its maintenance, as long as you aren’t advocating violence or anything (in which the case such terms have a rational basis), then you are probably onto something. Such terms are often the means by which those inhospitable to change rationalize this bias for things as they are and forestall the possibility that the ideas which might help give traction to, or usher in, this change, may gain currency.

    It’s a kind of thought-terminating cliche, in the sense of a statement so vague and succinct, it is difficult to respond to it.

  • Cledwyn Bastardo

    That should be “quo”, no “the case”, but “case”, obviously

  • Cledwyn Bastardo

    “There is, in my view, no possibility that a system led by psychiatrists will ever become truly helpful….”

    Obviously, I wholeheartedly agree. I think the attempt to reform institutional psychiatry is a tad quixotic, although the impracticality and idealism that this denotes are used to characterize our position (and you know what, it could just be that both are correct).

    The disease model has to be done away with, partly because of its empirical bankruptcy, and partly because of its disempowering character; it is a belief that fulfills itself, because if one sees oneself in terms of the powerlessness this model implies, one becomes powerless.

    On top of this it prescribes medical solutions for problems that fundamentally aren’t medical in character, although the solutions beget real medical problems.

  • Cledwyn Bastardo

    That should be “the use of such terms has a rational basis”.

  • Neo

    Sheet I’m thinking these ECT clowns need to be prosecuted and locked up. I was being too kind thinking they were dissociating. Now I’m thinking some of these guys are definitely psychopaths. CLASS ACTION TIME. Good job anonymous. With my eyes I see a bullseye target nearby. Follow the arch even a blind squirrel can find the golden acorn. Take down that MIT of the Mississippi WUSTL. And GO KU! LOL

  • barry

    Funnily enough i’m beginning to like this blog. A state of ‘conflicted ambivalence’??? What the hell does that mean? You are either ambivalent – feel attraction and hostility simultaneously, or you aren’t. There is no need to add conflicted. So really the authors position is a veiled defence of the status quo, one no doubt that will be welcomed by the rest of the profession. The validation of the alternatives ends just there. It does not result in Action. So is it sincere or not?
    A more forthright person may be tempted to label the author a sychophant, but it might be the trepidation of starting a blog that made him hesitant. I hope he continues to have doubts, as this is a good quality, and without it you have no hope. Promising start.

  • Neo

    Nothing more enjoyable than coming to the realization that psychiatrist are clueless when it comes to psychoanalysis.

  • cannotsay

    Speaking of NYC,

    http://www.nytimes.com/2014/08/05/nyregion/us-attorneys-office-reveals-civil-rights-investigation-at-rikers-island.html

    “In an extraordinary rebuke of the New York City Department of Correction,
    the federal government said on Monday that the department had
    systematically violated the civil rights of male teenagers held at
    Rikers Island by failing to protect them from the rampant use of
    unnecessary and excessive force by correction officers.

    The office of Preet Bharara, the United States attorney in Manhattan, released its findings in a graphic 79-page report
    that described a “deep-seated culture of violence” against youthful
    inmates at the jail complex, perpetrated by guards who operated with
    little fear of punishment.”

    So I would not consider law enforcement in NYC as the best example of what respect to civil rights looks like in the USA!!

  • Neo

    Help me with this friend. It’s been bothering me for a long time. https://plus.google.com/104137305374302309388/posts/3763rzdGLKQ
    At around the :47 second mark actor James Woods starts fumbling all over the place. He says “jurisdiction” when it appears he meant to say “trial.” That is rather odd coming from a 180 IQ and particularly odd to me because I can’t figure out for the life of me what he would have meant by jurisdiction. Who other than the Justice Department would have jurisdiction over prosecution of criminal acts such as these? WTF is he talking about? So, please look over the entirety of the tape and see if there is anything else you find odd.

  • barry

    Hi Neo, it just leads to a series of ‘what if’s?’. Question motivation to speak publically. All about intrigue. Cheers, Barry.

  • Neo

    I think you’re right. Truth is often entangled with a mixture of things. Befuddlement is one of the easiest conditions to create. Red herring is a favorite dish some like to serve. This one is rabbit hole for me, unless James Woods ever chooses to enlighten us.

  • Neo

    What I like the most about Hickey and most of those posting here is that they all know Jack.

  • barry

    When did this appear on tv? Recently? I live in the UK. For me, it seems very strange that someone would go on tv and behave like that. He has a mask like face. Eyes don’t give much away either…

  • Neo

    Feb 15, 2002. So much of what we believe is based upon disinformation and false assumption. This is particularly true when it comes to psychiartry and even medicine in general, matters upon which I am trying to gather my many thoughts.

    I have come believe strongly in a near limitless power of human mind to heal and even create. I was once involved in a factual situation very similar to that of James Wood’s. I was later haunted by my inaction. I believe James Wood’s suspicions were actually premonitions, as were mine. Other support includes his conveniently vague description of the basis of his suspicions, other passengers in first who did not make similar reports, his obsession with mind reading as evidence by his poker and having sought out this new TV show he is involved in.

    To add to the intrigue his father worked in military intelligence and he himself strongly favored the politics of Bush. But, all of that could be misdirection. My guess, and is that if there is funny business he was not part of it, but somehow may have gleaned some things from the questions these agents where asking.

    Perhaps of great significance is the fact according to some the relationship between the FBI and CIA was on of animus. I side with the FBI FBI agents are lawyers. s. akin to that of the KGB and o minds of some were come to question became aware of it. Lots and lots of questions I would love to ask him

  • Neo

    “So, by all means let’s make an APA Mind Game of this and have all the psych residents in training join in to help me with my diagnosis. Hmmm . . . I think some of them already have.”

    Hey Barry reading my stuff is doubly fun.

    PS. Hickey, this is truly unrelated but could you please delete that photo shop as I have better. All that befuddlement got me wrongly associating STAR GATE with that absurdly spooky movie about goats. STAR GATE proved RV to plenty enough certainty.

    http://www.espresearch.com/examples.shtml

    But its like Morpheus said, “I can show you the door, but its up to you to walk through it.”

  • Neo

    Jack Schwarz knew how to heal mind and body . . . with what God gave us–mind and nature. Now why don’t we know this?

    I’m not a scientologist. I know nothing of it. But why then do I have this negative view? How did I become prejudiced? When I’m prejudiced, I don’t know Jack.

    Why do I have a negative view of naturopathic medicine? On what basis did I formulate that view? Why did I not give it a chance? Why don’t I know Jack? I’m sure John Lennon would agree, there can be no better hero for humanity than Jack Schwartz.

    Keeping opening your mind and working at becoming a critical thinker. Eventually you ask questions like, “now who would be interested in preventing me from knowing that?” Then you’ve almost graduated to the wisdom of those like Jack, like John, like Stanley, and then quit calling you delusional and call you a conspiracy theorist.

  • barry

    What was really strange was that they put Actor up on the screen. Surely it is James Wood, member of the public, in this context. If someone tried that in the UK there would be outrage, because people would come to the conclusion that he is trying to make money from a situation where fellow civilians died. Vile.

  • Neo

    I did notice how despite all this fear of backwashing information (which can be legit in other contexts) he nevertheless managed to divulge enough information regarding the identities of the hijackers to support the Bush Chaney talking point excusing their ignoring advance warnings because not even the terrorists themselves knew what was going down because they were all operating independently out of separate secret sleeper cells. OMG “sleeper cells,” what an utterly delusional scenario. No these dudes were all working together from the beginning. I still don’t know where my bud James Woods is in all this. I’m hoping he has somehow found his way to see the light.

  • barry

    Like you say, he (woods) has a poker face, some connections with important people, and the rest people fill in themselves. I expect there will be a whole series of films made in the future, maybe like Oliver Stone’s JFK.

  • Isis

    Your take down of ‘BPD’ is a hoot. I’m compiling critical content on the label for a blog and I’d love to include it.

  • Phil_Hickey

    Isis,

    Of course. You may use any material from the website. All I ask is that you credit me with authorship. Let me know when your blog goes up.

    Best wishes.