My Fixed Delusion

This post was submitted by a reader.I’ve spent my adult life working in mental health services.  I worked for 15 years in residential treatment with adolescents, and another 15 years in large outpatient programs with adults.  I’ve been in clinical roles and leadership roles, primarily as a group therapist.

I am a strident cognitive behaviorist. I’ve been a passionate and sincere student of human behavior for as long as I can remember. I respect the scientific method, and try to maintain critical thinking.

Obviously I haven’t been a true believer in the psychiatric standard of care for a long time. At some point I became a skeptic. However, I never stopped to consider my suspicions could be evidence of a serious mental illness until it was suggested to me by my supervisor in a “counseling” meeting.

Although it’s hard to specify when the seeds of my insanity took root, the documentation of it began shortly after I donated Robert Whitakers Anatomy of an Epidemic  to our clinical library. I suggested that Whitakers statistics mimicked trends in our own clients.

Questions of my sanity first came up behind my back.  I only know about it from a former coworker, after she switched allegiance.

Months passed. Whitaker’s statistics clearly correlated with the day to day, person to person anecdotal evidence in our patients. I was especially interested in the people who returned to us, months or years after being discharged. What these people had in common was that they accepted their illness and complied with medications.

Obviously I shared my observations with my team. I was eventually able to form something of a predictive template for bad outcomes. I wasn’t surprised by the initial defensive reaction. It’s an understandable reaction to cognitive dissonance.

I was surprised that as evidence accumulated (and accumulate it did) the defensiveness only deepened.

The official pushback began gently. I was invited to counseling sessions, offered more trainings and greater supervision. I believe they genuinely wanted to bring me back into the fold.

It was no longer gentle after the fourth or fifth disciplinary counseling session. They had to come right out and tell me to “stop telling people they can get better.”

Ultimately they expressed their concerns for my own mental health, which they assure me, were shared by many members of my team. Although they declined to offer a specific diagnosis.

My boss asked me “how, could you be the only person who sees this big conspiracy?  

A valid question, it must be said. And I had no immediate response.

This, after all, actually is a definition of a delusion, especially now that the DSM 5 is the new standard.

Perhaps, all this time I have only been in denial?

I developed a list of all the crazy things I believed.

There are no lab tests of any kind for any DSM diagnosis. The diagnosis is subjective The diagnosis can’t be tested for, measured for severity, or tested against.  The current system lacks validity and reliability. Everyone inside the system seems to acknowledge this, but simultaneously insist on treating a diagnosis as sacred.

For example: It is rare that two psychiatrists in our network seeing the same patient will arrive at an identical diagnosis.

And Any legal case involving competing psychiatric testimony will demonstrate how two experts can examine the exact same evidence for as much time as they care to and arrive at completely contradictory conclusions.

Psychiatry is faith based medicine.  It discourages second opinions. Psychiatry places an institutional priority in convincing people to “accept their illness”, even at the expense of informed consent.

The chemical imbalance theory had been completely debunked even before Prozac came out. This is so well known that psychiatric talking heads are even now trying to pretend they never believed it.

Psychiatrists who did promote the idea, or continue to present it, are simply misleading people for their own good.  The “stigma of mental illness” justifies a little coercion. Since, obviously, the people who accept their illness and comply with medications will have the best outcomes.

Except that there is very little evidence that people who get treatment have better outcomes then people who don’t. In fact, the worst outcomes, (chronic illness, disability, shorter life span, suicide, violence) are associated with people who have been exposed to treatment, especially across time.

By “treatment” I am referring to medications, and/or psychotherapy. Although psychotherapy will not cause weight gain, diabetes, and shorter life span of medications, it is far from benign.

1 in 5 Americans are currently taking a psychiatric medication. Yet the conventional wisdom holds that not enough people are in treatment.  The numbers are often repeated “40% of mental illness is untreated”. Which led a recent APA president to declare “the greatest challenge facing psychiatry is untreated illness”.

Prescription drugs are now the leading cause of death in young adults. Opiates being the worst, but psych meds are frequently involved, particularly benzodiazepams.


A recent CDC report on suicide confirms one of my less documented long standing delusions; The suicide rate (for mental illness) has never been higher, and most people who kill themselves are in treatment when they die. Many people were not suicidal until after they got into treatment.

It surprises even the most experienced clinicians fail to realize that there is no treatment proven to prevent suicide, simply because you can only accurately measure suicide in those who succeeding in killing themselves. In other words, those who failed in treatment.

Suicide prevention consists on a series of assumptions we make about why people kill themselves and what they need from us to not die.  Mostly this amounts to drugs, talking at length about why life sucks and is futile, and being very subtly rewarded for making existential threats and gestures.

As far as I can tell, most of the mass/spree shootings in America involve people who have been exposed to treatment.   And, as far as I can tell, mental health professionals are as good at predicting violence as the CIA was in predicting the fall of communism.

Because of the legal requirements for disability, 100% of the people permanently disabled by mental illness have participated in treatment, usually across time. No one has slipped through the cracks to disability, simply because it requires a doctor’s efforts to become successfully disabled.

And the disability rates are staggering and unsustainable. I suspect they increase wherever psychiatric treatment is more widely available. It is not uncommon for a person to have maintained an occupation and social role without any treatment at all, only to become disabled after getting into treatment.

I suspect the same correlation can be found in the divorce rate and availability of marriage counselors. The incidence of unresolved grief and the availability of bereavement counselors, and the rate of ptsd and the availability or trauma counselors.   As I said, therapy is not benign.

Obviously there is a very clear financial incentive to encourage chronicity, since we can’t charge someone who recovers. There is no profit in recovery for the treatment provider. Like any other business our best customers came back over and over again.

And treatment is the only item on the menu. The only option for someone who clearly deteriorated after getting into treatment is more treatment.

The people who become chronically mentally ill are our best customers.

People who pursue disability are particularly profitable, because they will engage in treatment in order to secure documentation, and don’t complain when treatment fails. They may come back to inpatient several times in the two years of appeals in order to demonstrate and document their incompetence.

Like any other faith based system, its impossible to disprove a negative. I can’t disprove God any more then I can disprove restless leg syndrome. Or Asperger’s, or ADHD.  Faith and denial are evidence resistant.

Certainly my sincerely held beliefs conflict with widely held conventional wisdom, which is the very definition of a delusion. And now I have been diagnosed by several skilled and experienced mental health experts who knew me well. Yet I don’t accept my illness, which constitutes anosognosia, more evidence that I am indeed insane.

The last year at the hospital was bad. I hired a lawyer. I went to work every day expecting security to come walk me out. I attended six therapy sessions through our EAP program.

The whole thing ended rather quietly. I was downsized and given a generous severance package. People cried when they announced I’d be leaving.

I can’t find anyone in the field to work for who has managed to avoid the corruption, and even if I could, who would want an old group therapist with a fixed delusion? The people with integrity went out of business a long time ago.  These days I run a very selective online private practice and produce a podcast about the dark underbelly of the mental health system. The podcast is called anosognosiac, and you can find us on iTunes.

I did find an answer to my boss’ question that troubled me “how could you be the only person who sees this?”

I am not the only one. Many other people have come to the same conclusions I have. Many are articulate and offer compelling evidence.

Also, since leaving the hospital I’ve been quietly approached by some of my former team members, including one who participated in my diagnosis, who admitted they actually saw the same problems I did, but worried over the consequences of speaking out.

I have mixed feelings about this.  On the one hand its vindication. On the other hand, some of those professionals looked me in the eye and made me question my own sanity.


A Reader

  • Mark Eccles
  • Growing

    I also work in the mental health sector, my role being to promote the “Recovery Model” while at the same time helping people to prove to bureaucrats that they have long term and serious mental illness that requires lifelong disability support. I frequently speak out to colleagues about the contradiction between these two aims but am very careful about my choice of words and also to whom I speak. I hope, however, that should I find a colleague more strident in their critique of the system, that I will have the courage to back them.
    For my part, I also work voluntarily with groups and networks that promote true personal recovery. I also seek to generate more community based support for people with mental health problems. I seek out caring community members who are willing and able to look through to the real, struggling human being behind every mental illness and offer authentic human connection through something as simple as a regular coffee gathering, for example. In my experience, the offer of authentic, non-judgemental, ordinary friendship can provide a key to unlocking the person’s lost sense of intrinsic value, and also hope and motivation for them to seek out help for recovery rather than help for disablement.

    These are small things that I hope will add to the sum total of grander efforts such as your own, Phil’s and the many others who are making a very reasoned and eloquent case against what seems to me to be a serious social maladjustment. I trust that over time, reason will prevail.
    “Truth is the ultimate victor. When all attacks upon it have exhausted themselves and the smoke clears, there stands truth, as strong as before.”

  • all too easy

    “There are no lab tests of any kind for any DSM diagnosis.” you know who.
    This dude is hilarious. What is a lab test, bucko? Is life a lab test? How ’bout common sense? How ’bout close observation by those with no vested interest in the outcome? How ’bout the testimony of folks who have found incredible benefits from modern psychoactive medications? How ’bout taking Whitaker’s nonsense as nonsense? (You think testing outcomes are full of bias, try reading his garbage without having fallen for him, first.)
    The greatest threat to these poor people is their propensity to deny their own mental illnesses and their compulsion to fight everyone and everything that reaffirms that they are sick. IOW, these people, who are in desperate need of staying on their drugs, want to be in charge of their doctors and their hospitals. Their illnesses convince them that everyone who disagrees with them is their enemy.

  • Lm1503

    As an anti dsm-er and clinical psychologist I can relate to your position of being pulled into the facile diagnostic frame of thinking by professionals around you. I commend you for pushing back for as long as you did, when the negative consequences were so powerful and so personal. As you say we are certainly not alone. The division of clinical psychology here in the uk has essentially made it official that labels and diagnostic categories as they pertain to mental health are not considered scientific. This is a huge step and means that the type of views you express which go against psychiatric thinking can longer be considered fringe. Best of luck with your podcast.

  • The Right Honorable C. B’Stard

    It’s funny (well, not really funny, but you know what I mean) that they say you are delusional, that being exactly what they are.

    They are like the monkey in Krylov’s fable; scoffing at their own image in the mirror.

    The line separating sanity from insanity, arbitrarily drawn through human society, runs through the very heart of man. Almost always when labeling a man delusional, the tacit assumption is that we are not, and that we, by grace of the god of Reason, see things as they are.

    This is nonsense, because the human brain simply hasn’t evolved along the lines required to turn us into the philosophical wayfarers we fancy ourselves to be. The only way we can maintain our balance on the emotional tightrope on which a human life is always precariously poised is by striking a compromise with reality, and when necessary, moving our habitation, to lands most remote in the imagination (La Fontaine).

    Every mind aims at a certain equilibrium by means of which life is made (barely) endurable.

    The high-minded ideology of mental health practitioners and the fairy-tales they tell themselves about what they are in engaged in allow them to maintain this always artificial balance.

    It is impossible to understand the defensiveness of these people without first understanding this.

    As with psychiatry, so with society itself, and psychiatry being an institution of society, it upholds the illusions that form the basis of society’s continuity, such as the illusion that life is good, a gift of which even the most miserable and oppressed are supposedly the fortunate recipients, allowing the flesh that society presses into service to go on multiplying ad infinitum, as if in some nightmarish hall of mirrors, whilst in the mean time, life, this turd wrapped in tinsel, beneath all its superficial splendor, proceeds along its usual brutal and degrading course.

    Society and psychiatry persecutes the miserable largely because their misery often bears witness against both the social order and the world, and thus constitutes an attack on the whole edifice of bullshit upon which a society leans for support.

    Some might ask, how could such a conspiracy happen? Which is, of course, a loaded question, as I imagine it was when the author of the above article was asked something similar. Unless by “conspiracy” is perhaps denoted one that even the conspirators are not necessarily consciously in on, the point being that what we tell ourselves and what we actually do and work towards are two different things, and rarely do the twain meet. Beyond the scope of conscious rational thought, people often intuitively understand when something is not to their personal advantage, and act accordingly.

    I don’t think the divorce rate has anything to do with marriage counseling; you don’t need to go and see a counselor to know you are in hell, and to take the requisite corrective measures.

    Whenever someone says they are engaged to be married, I always offer my most sincere and heartfelt condolences, after I’ve asked them when the funeral is.

    We lock certain people up on the grounds that they are delusional, that they are dangerous to themselves or others, and out of supposed compassion for the hell into which we can supposedly see them spiraling. Yet when a delusional and decisionally incapacitated man and woman join in unholy matrimony, we allow them to proceed with their madness unhindered, even though we all know from experience, from observing the psychological and physical carnage characteristic of conjugal relations, just what they are letting themselves in for, and does the state intervene?

    Or perhaps it is only us connoisseurs of crucifixions who can see the truth of the mutual martyrdom of matrimony.

  • Karen Kilbane

    Brilliantly articulated.

  • Cledwyn Gallows Buffoon

    Suicide prevention is existential slavery. To paraphrase Montaigne, where the freedom to dispose of our own person is wanting, life is slavery.

    It effectively reduces people to the status of human chattel.

    Much as society loves to pretend otherwise, the obvious truth is that it does not give a shit about you as a human being, which is absolutely fine, just please, spare people the charade. Directly a man pops out of the womb, he is pressed into servitude. It provides for and preserves us for the same reason that the slave-master fed and looked after his slaves, not for any humanitarian reasons, not because it actually cares about the soul it crushes from cradle to grave between its millstones.

    Society values people only insofar as they are productive, save, that is, its idols, for it is always, so to speak, going into convulsions and shooting its collective load over some idol, slathering its semen over some thug, so that one cannot venture abroad or turn on the TV without getting splattered, splattered as a result of the figurative epidemic of public masturbation that takes hold of society in every age, and to which all must lend their willies. Excepting such people, the truth is is that society at large is indifferent to you in anything other than utilitarian terms, so that in laying claim to the lives of aspiring corpses on compassionate grounds, of people who wish to turn their misery to good account by killing themselves, it is being more than a tad insincere.

    Psychiatry, as an executive organ of the state, enforces de facto slavery laws when its practitioners intervene violently in the lives of people seeking to correct the mistake of the lunatics who created them, only to find themselves subjected to “that last and meanest unkindness, treachery to a would-be suicide” (Twain). All this tediously sententious talk about ethical imperatives, and this insufferable finger-wagging, schoolmasterly flatulence about duties, is all just a part of the universal traffic in bollocks.

    As for all this messianic piffle about saving lives, mental health professionals – mostly phony philanthropes trading in on our trust – are always waffling on, mercilessly, about how they want to help people, all so that they can get their snouts all the more snugly settled in the trough.

    How about putting your avowals of bottomless solicitude to the proof, and seeking new employment?

    “…mental health professionals are as good at predicting violence as the CIA was in predicting the fall of communism.”

    The belief that psychiatrists can or ought to be able to predict such things is a symptom (not in a medical sense) of the delusional madness of the masses.

    People are control-freaks, and cannot stand uncertainty. So they take refuge in the rather grandiose delusion that they possess some sort of faculty for predicting the future, or in the belief that our beloved experts can.

    The examples are too numerous to comprehensively enumerate. We predict that under great situational and psychological pressure we will do what is right, but when circumstances put our predictions to the proof, we usually buckle.

    The future is a messy business, full of unforeseen occurrences that make a mockery of all our plans and our predictions.

    The world of sport furnishes many examples, because sports, apart from its obvious corrupting and brutalizing effect, fosters mindlessness, for which reason in our country there are so many government initiatives encouraging children to take up sport, government initiatives encouraging children to take up mindlessness (though men need little encouragement in this respects).

    Boxers always say what they are going to do beforehand to their opponents, usually setting themselves up for a pratfall. Pundits claim that this or that sports star is going to go on and dominate the sport, and then he drops dead.

  • all too easy

    “Much as society loves to pretend otherwise, the obvious truth is that it does not give a shit about you as a human being, which is absolutely fine, just please, spare people the charade.” Paladapuss the Fellating Mass Phallus
    Absolutely brilliant, Palady. Deep. Articulate. Profound! Genius! LOL
    Palady knows these things because, in case you hadn’t noticed, he has convinced himself–quite rightly– that he is gawd!
    Jerk, you have no idea who cares about whom and who doesn’t. However, what is knowable is that your holier and more brilliant than others attitude proves you reap what you sow. The disdain which you encounter everywhere is merely an example of that truism. That my beloved jackas is the reason people can’t stand you.

  • Anne Watmough

    In response to the story ‘My Fixed Delusion’ -The definition of ‘Delusion’ is something happening as seen by an individual that is proven not to exist. The definition of ‘Igorance’ is the lack of ability to learn new methods of constructing objects and of grasping new proven theories. Well enough to apply this knowledge to either improvement of surroundings or existence. Definition of ‘psychiatry’ theoretical beliefs based on no sound scientific proof applied in the treatment of an illness of the mind caused by a chemical imbalance believed to exist without research that this exists at all. In fact it is everything made up of fictional theory not fact. And which profession is given credulity by big pharma and their corruption.

  • Rob Bishop

    As a cognitive behaviorist, how do you respond when people react with objections and anger regarding the perspective that emotional difficulties originate with thinking patterns and habits? Many people feel they’re being blamed for their problems when the subject is discussed.

  • all too easy

    Can anyone prove that pain is real?

  • Anonymous

    I have verified, that this person did not perpetrate forced psychiatry. I don’t know why I had to email him to ask, it should have been mentioned in the article and Phil should be requiring it, the audience wants to know. Thank you.

  • Robin Macomber

    Dear Sir or Madam,

    You are not the only one who feels this way, or have made what to many of us are obvious, evidence-based observations concerning the validity of our current healthcare system especially where mental health is concerned. If one considers the big picture wherein most research funding comes from private, profit driven corporations whose sole purpose is to sell their products your point of view is far more sane than the mainstream. I am new to the site, and to the field of psychology and cognitive science but I’m quite inspired by your words and thank you for posting.

  • Circa

    I don’t think that definition of ignorance is very accurate. The “lack of ability to learn new methods ….” has more to do with low intellectual capability. Very intelligent people can be ignorant of quantum mechanics – that doesn’t make them stupid, just ignorant of the subject.

  • Anne Watmough

    Hi Circa,
    Re: the comment to ‘My Fixed Delusion’. I believe as human beings we have a capability that is above that of other creatures that live on the earth and there are no barriers between our learning capcity. That everyone has the capability to grasp new things and learn new projects that it is just the way it is introduced to us. That people are taught how to learn not just to learn and we are all capable of striving to improve ourselves.

    That is why I said ‘Ignorance’ is the lack of ability to learn new methods and projects not because we have low intellectual capability but because we haven’t been taught or shown in the correct way.