A rational argument against psychiatry

First off, let me say thank you for these forums and thank you for setting up this anti-psych forum explicitly to allow such discussions. I have been banned several times (most recently, for life) from http://www.crazyboards.org for expressing and debating anti-psychiatry views -- frequently treated very abusively by the site's maintainers in clear violation of their own rules of conduct, which they would justify by saying that anti-psych views were dangerous and harmful to their pati-- er... members.

I therefore understand how controversial, potentially upsetting, and yes, dangerous such opinions can be. So before I start what I hope will be a lively discussion and even debate, let me first make a few qualifications. You can skip to the second post to see the actual argument laid out.

#1: Do not stop taking your meds. This is very dangerous, no matter what your condition. Even unnecessary meds for non-existent conditions have very strong habituating effects on the brain, and will more often than not cause extreme reactions if stopped suddenly or even as quickly as the average doctor will "taper" people off them. Often such reactions are equal and opposite to the desired effect of the drug, and are therefore misinterpreted as even more severe underlying pathology than had been presumed, resulting in re-prescribing at higher doses or adding new diagnoses and new prescriptions. Often such reactions are totally new and surprising. Seizures, dizziness, nausea, insomnia, mania, tics, mood swings, panic attacks are all par for the course (in fact, every one of these is linked to the commonly prescribed anti-depressants).

#2: I am not saying mental illness doesn't exist. I am not saying medications do nothing, or that they do not help anyone. I am not saying you will cure your mental illness by following my 8-point plan to holistic well-being. Anyone who accuses me of any such nonsense is not only being glib and ignorant, but does not deserve a place in the conversation because they aren't paying attention.

#3: Given where I'm posting this, I might expect I'm preaching to the choir, and so needn't expect a backlash the likes of which I experienced on http://www.crazyboards.org (check it out). However, I hope for real debate over points. This isn't a soapbox, it's an invitation for rational dialogue. Therefore, I also hope that those who disagree with me or anyone else will adhere to the posted rules of engagement and restrain from name-calling, abusive or rude posting, etc., and will instead attack points of disagreement with rational argument and/or cited research data.

#4: If my views offend anyone, you've been warned, both by the site's creators in their rules about posting, and by me. I do not aim to offend anyone or dismiss anyone's problems, and believe me, I've had plenty of my own experiences as a "consumer" of mental health services. I am sympathetic. My goal is to keep digging at the truth. I am NOT a doctor, I am NOT working to cure anyone here, and I have no ulterior motives other than this pursuit of truth.

A brief(ish) history of psychiatry

Psychiatry has a long and checkered history. Many consider psychology to have first come into its own near the end of the 19th century, officially branching off from philosophy by establishing for the first time the use of the scientific method to investigate the mind. Many think of Freud as a founding figure, and indeed it was Freud who first made use of the medical milieu to legitimize what was still, in point of fact, a dark art with little in the way of science to its methods. Freud was an astute observer and was very clever in advancing theories of the unconscious -- his most lasting and important contribution to psychology. He proposed the revolutionary idea that much of our behavior and mental life arises from unconscious (i.e. things we are not conscious of) processes and motivations, and that these unconscious processes in turn were generated by our early life experience. This idea remains a central axiom of many schools of developmental psychology, personality theory, and popular wisdom.

Less well-known about Freud was his foreshadowing role as one of the earliest psychiatrists. Freud loved cocaine. He wrote about it as a cure for many maladies, a miracle drug for the mind. He mailed cocaine to friends. Freud, though he had a formal medical education (his dissertation was on the spinal cords of fish), did not have the benefits of the extensive training in over a century of psychological research that today's psychiatrists have, so he could hardly have known that he was prescribing a dangerous, addictive, potentially life-shattering drug. Certainly his actions by today's standards would be considered gross medical negligence. Right?

The 19th century also saw the dramatic rise of the asylum. This rise has often been attributed to the urbanization of society and its increased systematization of life. People in urban society are more specialized, have more education, and are competing in a more pressured ecomony. Those who previously would have been supported by the community because they had difficulties that made them less competitively productive and less able to assimilate into a broad culture beyond local clans became more problematic. The asylum offered the most economical solution of its time, which was to sweep such people together where they could be kept out of the public's way, looked after since they could not take care of themselves, and studied to determine the mysterious causes of these pathologies of the soul (as was the predominant Western view of madness in the early 19th century). Conditions in asylums were barbaric by today's standards, with the insane routinely kept in restraints, kept in unsanitary cells, and subjected to much of the inhumane treatment common to prisons throughout history. Following the discovery of genetics, many of the insane were sterilized to prevent their madness spreading. Later innovations included removing the frontal lobe of the brain with an ice pick, and delivering massive electical shock to the brain, both of which were proven effective at making the insane more docile and manageable. By today's standards, psychiatry at this point in the mid-20th century had its collective head up its collective ass regarding any understanding of the actual workings of the brain and how these related to mental development and health.

It was in the early 1950s that a few new miracle drugs created a revolution that would make practices like lobotomy and ECT seem barbaric. Chlorpromazine, a drug marketed for anti-nausea, was found to have a strong sedating effect. If given to psychotics (a term originally used by Freud as distinct from neurotics, which has gone through so many meanings it has been rendered rather meaningless historically, though its generally meant alternately "out of touch with reality" or simply "really ######6 insane"), the drug was seen to calm aggression and hallucinations. It effectively made the insane more docile and manageable but without the electric bill or the ice pick. This became the first in a class of drugs labeled "neuroleptics", whose use resulted in the rapid emptying and shutting down of most of the asylums. A more subtle revolution also arguably began with these drugs -- the beginnings of the chemical imbalance model favored by psychiatry today. If psychosis could be treated by the introduction of a chemical to the brain, logically psychosis must be caused by a chemical imbalance in the brain. Hmmm...

Within two years of its introduction, chlorpromazine and subsequently all the neuroleptics were seen to produce a crippling condition called tardive dyskinesia, a disorder involving twitching and spasming that results from severe dopamine changes in parts of the brain (the extrampyramidal cells and substantia nigra, related to motor control). Even worse, this disorder, once triggered, persisted with a majority of patients even after being taken off the drug. Despite studies demonstrating this with solid scientific methodology, the psychiatric establishment resisted the evidence and publicly smeared those campaigning against these drugs, saying that these reports were being blown out of proportion and were rare or even non-existent, having to do with certain patients (who after all, were already known to have defective brains). These drugs were creating a revolution in acceptance of psychiatry as a science and promoted the psychiatrist enormously as a hero who had helped cure the insane and shut down the asylums. Damned if they would be removed as quickly as they'd been provided by the drug companies. The neuroleptics continued to be prescribed as a mainstay until the early 1980s, when new damning research, couple with massive class-action law suits costing a lot of money to the drug industry finally saw these drugs out of favor. The new research data specifically showed that TD occurred in about 40% of patients studied who were taking neuroleptics, and that of those who developed the condition, 80% never fully recovered once taken off the drug. These drugs were subsequently renamed "anti-psychotics" so as to distance them from the memory of these scandals. They were also dubbed "major tranquilizers", in contrast to another form of drug which had been in use since the 60s, the benzodiazepines, which came to be known as the much more benign-sounding "minor tranquilizers".

This pattern is very telling, and has been oft-repeated since the 50s with every class of drug introduced. Drugs are introduced, hyped and marketed with great fanfare from psychiatrists, who invariably proclaim a new dawn of scientific understanding of the medical nature of mental pathology, devising new theories based explicitly on the reverse-engineering of the known action of the drug on nerve cells in a petri dish, and later active blood flow to regions of the brain under modern scanning equipment, marginalize and dispute any and all evidence of harm caused by the newly favored medications, and eventually, move on to much better, newer (and more profitable with new patents) medications, proclaiming finally that the older class of drugs has all these huge problems which the newer drugs avoid! While the numbers behind TD with the neuroleptics have not been repeated, it is also telling that the research evidence of the drugs' harm was actively opposed for almost 25 years before psychiatry conceded reality.

Another dramatic shift in the 1980s was the passing of new legislation in the United States that greatly reduced the oversight of drug companies as well as made patents on drugs far more lucrative. These changes made during the extremely pro-corporate Reagan era were huge factors in what was to become widely known as the "Prozac Revolution" of the early 90s, and the subsequent take-over of mental health care, research, and medical education by the drug industry. The drugs central to this revolution -- Prozac and the many copy-cat SSRIs (selective serotonin reuptake inhibitors) -- were so hyped and promoted as wonder drugs for depression, anxiety, obsessive-compulsive disorders, seasonal affective disorder, etc. while being completely safe, that prescribing and (by necessity of insurance coverage) diagnosing of many maladies skyrocketed in the 90s and early 21st century. Marketing saturated television and print -- are you sad, restless, unsatisfied? Doctors now know that this is caused by an imbalance of serotonin. Ask your doctor to prescribe [our new drug]. Well, doctors did not, and do not know any such thing. This theory was based on the action of the SSRIs, and has failed to stand up to scrutiny under a couple decades of fMRI studies. Just as cigarettes do not promote healthful vigor, and the miracle tonics of the 40s and 50s did not soothe angry blood. This is marketing that has been accepted widely as medical knowledge, simply because that is what the marketing taglines have said.

Meanwhile, the "minor tranquilizers" have been found to be dangerously dependency-forming, and banned in many countries. ADD drugs have the same pharmacological action as many illegal narcotics, and have been shown not to correlate to improved grades, college acceptance, or future performance, while they have been shown to increase aggression and violent behavior. As have all the SSRIs, where already several class action suits have shown that the drug companies knew as early as 1989 that such drugs were linked to increases in suicidal behavior, violence, aggression, and, oh... deterioration of the extrampyramidal cells already linked to tardive dyskinesia. Yes, doctor's have now reported many cases of TD-like conditions, tics and spasms brought on by SSRIs which may be most pronounced when the patient first goes off the drug, thereby stopping the masking effect (this was the same with the neuroleptics), and which sometimes, but not always, disappear with time once the drug is completely removed. SSRIs also can cause a condition called akathisia, which consists of restlessness, agitation, and can develop into full mania and psychosis. It has been asked, quite reasonably, by people on these forums -- how can a doctor tell the difference between drug-induced akathisia and "hidden" bipolar disorder that is "revealed" by an anti-depressant? Well, let's look at psychiatry's track record on such matters and think about the validity of that question.

Enough history

Okay, okay. Yes, you say, drugs have their downsides. There are some side effects that are more severe and debilitating, but these are rare enough to justify the huge upside, and for many people are welcome risks as a trade off to being able to function, to quell depression, anxiety, psychosis. After all, don't all medical drugs have their risks?

Well, I would agree but for one very significant caveat. These drugs might be worth the risks if they actually worked. That is, if the use of psychiatric medications were A) proven effective at improving the long-term outcomes of people's lives who would otherwise be crippled by mental illness, and B) if the drug was known to be addressing the actual illness, as opposed to, say, masking symptoms or even numbing someone as to their real emotional and situational problems. Conversely, if such drugs were simply masking symptoms of a deeper pathology, for which real healing were possible, I would say, taking drugs is not much better than taking cocaine or drinking to deal with ones problems. Sure, in the short term of months to a few years, medications offer far more stable patterns, less obvious ill-effects than these "street drugs". But in the long term, the effect would be very similar: escalation of unaddressed situational or relational problems, festering of unresolved emotional patterns or peresonality disorder. AND, as any true biologist might expect, gradual alteration of neural topology and brain structure that will sooner or later make dependency on the drug a serious reality. Further, I would say that if it could be demonstrated that medications, just like street drugs, may create short-term benefits but actually contribute significantly to long-term dysfunction and disability, then we need to actively discourage their widespread use and put far more resources into uncovering the actual causes for mental illness and the things we can do to truly heal people and prevent such conditions.

Glaring flaws in the psychiatric dogma

Firstly, let's look at some of the evidence that, indeed, medications are not actually promoting long-term mental health. After which, I'll lay out an alternative to the chemical imbalance paradigm, and see how it fits the same data. For the sake of getting this whole post written and up, I'm not going to dig up research citations here, but by all means, hold me accountable to any facts asserted. I can and will provide such citations, and I am begging others to provide data that refutes my claims.

The chemical imbalance model, it should be said, is not so actively promoted these days in many camps of psychiatry itself. Partly this is because it has been adequately enough debunked that it is less effective as propaganda. Partly it is because advances in brain imaging
are allowing more researchers and the psychiatrists who read about them in their monthly journal subscriptions to pursue more exotic and sciency models based on abnormalities in brain structures, rather than the overly-simplistic idea that a bunch of chemical spirits normally existing in "balance" but susceptible to a little too much here, too little there -- an idea which, let's face it, was discarded as a serious idea centuries ago after it was proposed by the ancient Greeks. That said, the gist of my arguments here apply equally to
the brain-structure-abnormality model.

What these models have in common is the idea that mental illness, and by extension mental health, are to some large part determined by the genes, or at least some equally physiological basis, and that such traits are therefore intrinsic to an individual, distinct from the population, and existing as a dormant reality even before any pathological symtoms arise. This paradigm strongly supports physiological treatment as primary, as well as the idea of life-long treatment to keep the disease in "remission".

Working backwards, if the underyling cause of mental illness is genetic, and we are of the more educated part of the population that undertands and accepts Darwin's principles of natural selection, we must ask, why are these genes, that demonstrably lower rates of procreation, general fitness, and competition for resources within our species, not only so prevalent, but apparently increasing in expression at a rate faster than new generations are being born? In other words, before we even locate these alledged madness genes, we must ask the rational scientific question, what is promoting these genes through natural selection? A simple explanation sometimes offered for such questions goes something like: modern civilization has obliterated natural selection through commitment to group welfare and society's assisting of the less able, blah blah blah. This argument fails to understand natural selection and/or observable reality. There has not been any noticeable period in our history when society has actually helped the less able (mentally or otherwise) have more offspring, or provided them with resources to become competitive in promoting their offspring with the general population. See above re: asylums, lobotomies, etc. In fact, to see such genetic drift as would have to be occuring to account for the rapid escalation of depression and psychosis (as two strong indicators of overall health), there would have to be some factor causing the bearers of these genes to have more offspring than the general population.

To be fair, not all physiological explanations rest on our genes. There are the microbial communities living throughout our gut, whose cells outnumber our own and whose genetic diversity has been linked to conditions like autism and shown to be negatively impacted by modern anti-biotic treatments. There's the fact that humans' diverse nutritional requirements
are increasingly strained severely by depletion of nutrients in the soil due to agribusiness, overfarming, and frankly, overpopulation and overconsumption. There's the loss of natural circadian rythyms since the dawn of the electric light, the intake of massive levels of industrial polutants, the lack of exercise resulting from planes, trains, and automobiles. All of these are physiological insults, most of which have been causally linked by research to incedence of mental illness. But they cannot be said to cause mental illness, or every person living in Los Angeles or New York City, breathing the air, buying from the grocery store, etc., etc. would be mentally ill. And, pointedly, no medication targeting selective transmitter receptors in the brain can possibly negate ANY of these factors, so they become moot when considering the central feature of the chemical imbalance model.

Another argument against this model is that since it is based on the efficacy of the very treatments being sold, it is quite reasonable to assume that the huge numbers of people being so treated should be lowering the overall incendence of active mental illness. That is, if depression is caused by a decrease in serotonin, and we are treating several million people with serotonin boosting drugs, we should expect to see fewer clinically depressed people. Likewise for ADD, bipolar, schizophrenia, etc. Instead, we see not just diagnoses of these conditions continuing to grow at staggering rates, most of all among teens and adolescents, but measures of the active aspects of these conditions are likewise increasing. Students' attention spans keep getting smaller, violence and aggression keep increasing, "self-medicating" with drugs keeps expanding, suicide rates are growing, the number of people seeking psychiatric treatment keeps growing. In the last 15 years, estimates of the percentage of the population suffering from bipolar disorder has gone from 1% to 5%. The common argument is that these rises are due to increased awareness and improvements in diagnosis. Really? How is that possible, when diagnosis is still based on subjective criteria derived exclusively from working with patients in the first place? Are we to believe that now that prescribing doctors include psychosis as a feature of bipolar disorder, there is a whole new wave of psychotics coming in and receiving a diagnosis who would previously have been ignored by the health care system? (The fastest rising class of drugs being prescribed are the so called "atypical anti-psychotics", which incendentally, have all also been linked to TD.)

Another argument: number and severity episodes of depression, mania, and psychosis among people who have had to move home with family due to their illness have been shown in research to be highly correlated to the degree of "negative cognitive styles" in their parents as evidenced in their interactions. That is, people whose parents have specific negative cognitive traits like constantly criticizing, projected thinking, poor shared focus of attention, etc., show higher relapse rates with more severe symptoms. Further, the same research showed distinctions between schizophrenic and bipolar symtomology based on cognitive styles of the subjects' themselves. E.g. those who tended to externalize conflict, seeing it as originating with the parent, were more likely to be bipolar, whereas those who internalized conflict, seeing themselves as the offending party, tended to be schizophrenic. The same research pointed out, curiously, that children of depressed parents were more likely to be diagnosed as bipolar than children of bipolar parents. All these data clearly show non-genetic causes to these illnesses.

And finally, how's this argument: if meds improve long-term outcomes of mental illness, why all the #######4 drug company marketing, the enormous lobbying expenditures, the huge capital investments of drug companies that allow them to have become the primary source of the required continuing medical credit education for doctors? Big Pharma spends twice as much on marketing as they do on research, and by one report teaches about 90% of CME curriculum by going directly to hospitals and providing seminars on illnesses which more often than not were first discovered and researched by the drug companies themselves. Why the growing controversies over the amounts of money being paid by drug companies directly to prescribing doctors? And the really big one, where are all the longitudinal studies showing that "maintenance" treatment with medication significantly improves the quality of life, the level of functioning, or even just the incedence of major mental illness? There have been a few studies showing the long-term reduced quality of life and functioning of those kept on long-term regimens of some drugs. A recent study following schizophrenics for 15 years showed those on medications were less functional, with more symptoms than those who had gone off medications. (See my point #1 above please.)

Instead, if you investigate the actual research, much of it conducted or paid for by the drug companies, you find that the vast majority is done on 1-2 month reduction of symptoms, that in many cases the actual efficacy is barely superior to placebo (and investigators who have inspected unpublished drug company studies report in many cases the same drugs failed to outperform placebos), the measures of efficacy are typically subjective, often patient self-reporting using biased scales originally developed, again, to help promote specific drugs, and that in many longer-term studies, this short-term efficacy disappears; the drugs do not sustain a reduction in symptoms compared to those untreated. In fact, many long-term studies show that non-intrusive treatments like cognitive-behavioral therapy are far more effective at prevention of future episodes than medication.

Okay, this is more true for some classes of drugs than others. And data trends never account for individuals. Some people will be helped, long-term, by some drugs, for some conditions. However the statistical reality is, most will not. Meanwhile, a very small portion of those treated will develop debilitating, sometimes permanent neurological disorders from the medications, and a far larger percentage will suffer more subtle impairments of memory, cognitive functioning, energy levels, sexual function, weight management, etc.

The alternate theory

Mental illness is caused by chronic distress.

Distress is one type of stress in the classic stress model described by Dr. Richard Lazarus. Stress is simply the demands made of a person -- physical as well as mental. When these demands are within our capacity to handle they can become "eustress" or "good stress", and in fact are necessary to our continuing development and fitness. When demands exceed our capacity, they become distress. Normally all of us experience some distress, but we are able to recover from the damage done through rest, sleep, nutrition, and even eustress. For instance, positive social interactions provide us with eustress that strengthens important parts of our brain and physiology, rewards us with shifts in transmitters and hormones, and in turn helps ward off some effects of distress. Likewise sex, strenous exercise, accomplishments and feelings of success, dancing, experiencing a great movie or a great book -- many things that put demands on us provide eustress and reduce the cumulative damage from distress. In this sense, you could accurately say that within your physiology there are various chemicals which are engaged in a constant, dynamic balancing act, and that indeed, when they become too imbalanced, discomfort can turn into disease. Illness. Pathology.

However to say that the disease was caused by the imbalance is rather like saying that one's bankruptcy was "caused" by the imbalance of credit to debt in their checkbook. No, it was caused by your poor budgeting, your addiction to gambling, and your bad investment in that failed tech start-up. The point is, the imbalance is a result, not a cause. Certainly as an imbalance, it becomes the cause of new problems (as with bankruptcy), and in many cases, taking some shortcut to push things back into balance may be desirable or even necessary. Get a high interest loan to pay off the debtors, find work to provide some cash flow, but very importantly, get your ass to Gamblers Anonymous. Because if you do not address the cause of the problem, all solutions are temporary, and you will find yourself back where you are, or worse, with even more debt.

Now the normal balancing act of your neurotransmitters, the hormones produced by various glands, the interconnection between these that is the endocrine system, and the interaction of all these physiological systems with your psychological realities (which in turn, if you are "in touch with reality", have a great interaction with your life circumstances), is incredibly complex and dynamic. The former has a lot to do with why we have so much to learn still about how it all works. The latter is another problem with the simplistic models of the drug peddlers. Your serotonin level is not set at some fixed place, but rises and falls with the time of day, with the season, with the stage of life, and, if you are healthy, with the external circumstances that those pathways in your brain evolved to help regulate. Ditto every other chemical, and ditto the anatomical structures of your brain, which continue to grow and rewire over a lifespan, as neuroscientists are finally beginning to realize with the study of neuroplasticity.

Some of this complexity has been mapped and linked to normal functioning. Serotonin is involved in regulating social status, or at least the dominance heirarchy in apes. It's involved in regulating wakefulness (and is directly linked to melatonin), and in regulating attention and motivation (and is inverselely correlated with dopamine levels, thereby connecting these functions to learning and rewards). We know that goals are connected to attention and that reward is connected to feelings of well-being and that hunger and sexual drives are connected to social dominance. We know a lot, but there is far more about these connections that we don't know, about how these interconnected circuits and feedback systems work that we can only theorize about. Some of the working assumptions though are that these systems evolved so as to promote our successful interactions with our environment, and likewise to steer us away from unsuccessful, unhealthy, or dangerous interactions.

To many, the word "environment" sounds like a synonym for "habitat". Certainly for our evolutionary ancestors, much of the these complex systems regulating the brain and body were about navigating the jungle or the plains. But for humans, there are two things that are more primary than physical environment. One is the social environment. We are by some definitions (and not others) the most social species on the planet. It is far, far more important that you know how to interact with other human beings than that you know how to kill prey, build a boat, or even change a flat tire. Much of the human brain as understood by modern neurology has to do with all sorts of complex social tasks, from reading emotional expressions to learning by mirroring physical movements in others to maintaining complex social maps of relationships within our tribe. So those same feedback systems deep in your brain that evolved over millennia to steer you towards successful interaction with the physical world have largely been retrofitted to give feedback about your interactions with other people, with the social world.

Many studies over many many decades have repeatedly found a very strong connection between individuals' happiness and mental health and the size and depth of their social networks, as well as the degree to which their life contained well-defined, stable roles. This supports the idea that this is the primary purpose to which our highly social brains have evolved. Where a rodent or amphibian brain gradually maps out the physical environment, learns which sounds to avoid, which levers to push, and otherwise relies very much on simple, genetic mechanisms to tell them which instinctive behaviors to activate when, a human learns a complex culture, absorbs and weights whole heirarchies of competing ideas and paradigms and strategies. Rather than relying on a small set of fixed instinctual behaviours, we accumulate memes -- recipes for non-instinctive behaviors too numerous to possibly be encoded in our genome, and too shifting and adapting to changes in physical environment, technology, structure of society, to be simply passed along as rote learning from each generation to the next. Where simpler animals' brains develop into maps of their corner of the jungle or pond which are nearly identical to the maps of their parents' brains, our brains each develop maps of a complex universe that is unique and by necessity vastly different than the maps of our parents' brains. Not just because we may relocate geographically, but because we are born into a different culture, and will come to know different people, with different value systems and different challenges, different resources.

Are you lost yet?

The same biochemical feedback mechanism that tells a chimpanzee that he has been shamed for picking a fight with the wrong female in the presence of an alpha male is operating in our human brains, telling us, well, potentially exactly the same thing. And when events like this happen, our complex psychological map interacts with our physiology to shift our serotonin (and dopamine, and norepinephrine, etc, etc) so as to produce changes in our behavior. We may experience such shifts as feelings of guilt, or shame, or sadness. Ultimately, these events are processed against the matrix of stored past experience which comprises our model of reality, and allows us to put the event in perspective. It is the chemical shifts that allow us to do this with any degree of intelligence. Just like people born without pain perception do not have long life expectancies, never learning to avoid dangers like hot stoves and often dying of serious injuries, a person without a functioning chemical system telling them when they are succeeding and failing would eventually "fail to death". The point being, there is a biological need for negative feelings like sadness and guilt and fear.

But what about when these systems get pushed beyond their normal operating ranges? How much sadness is too much sadness? How much fear becomes maladaptive? At some point, these systems appear to become so pushed -- by so much distress -- that their functioning spills over beyond evolved intentions and becomes dysfunction. There are those who have argued that mental illness is an entirely contrived construct, a myth promoted by society to push down dissent, etc. I am not an advocate of this viewpoint. Yes, dissenters will in general be pushed towards mental illness as they are at odds with their primate tribe, after all. But I see no hidden conspiracy, nor do I agree that mental dysfunction is somehow entirely subjective. If you cannot sleep from agitation or are battling invisible flying creatures all around you, your model of reality has become unhealthy. Period. You are ill.

But then, aren't we back where we started? Haven't I just explained how mental illness is the result of chemical imbalance?

What all this is saying is, at certain levels of imbalance, the imbalance must be dealt with, quite possibly with medications (though these are not the only proven tools), but that what also must, in all cases, absolutely be dealt with in order to return to a state of true health is the chronic distress. And therein lies the rub, as far as psychiatry goes. While every respectable study I have yet read that looks at long-term treatment of "Axis I" DSM disorders like depression, bipolar, anxiety disorders, and psychosis claims that "the data support that the best treatment is some combination of medication to resolve acute [...] combined with cognitive/talk therapy...", the reality of the health care system is that tens of millions of people are simply being given drugs. Often indefinitely.

There are several potential reasons for overwhelming distress. For the sake of brevity (hahaha), I'll just outline them:

- One's situation is untenable. If you are being beaten or sexually abused, are being held without trial as a political prisoner, lost your entire family and home in a disaster, have just been told you have 3 days to live, etc., you may experience mental illness with no visible recourse. In some cases, this lives up to the concept of mental illness as "spiritual crisis". You may be much better off seeking a religious figure, a trusted and wise friend, or even disappearing in a dissociative fugue than you would be going to a psychiatrist.

- One lacks adequate resources. Rates of most mental illnesses increase dramatically among those living in poverty, for instance. Immigrants lack cultural connections or even language to help them gain access to common resources. People's families may be "emotionally impoverished" or otherwise dysfunctional, depriving them of resources for love and guidance. Finding support groups, education, friends, etc are all pieces of the solution.

- One lacks skills. This can mean lacking marketable job skills as well as lacking interpersonal skills. Lacking assertiveness or emotional maturity, one will struggle to make use of common social resources just as the foreign immigrant does. Research has shown that 1/5 to 1/3 of all admissions to psychiatric hospitals in recent years are diagnosable as having personality disorders. Such disorders are ultimately lack of developmental skills necessary for successful navigation of the adult world, and are highly correlated to various other mental disorders. Cognitive therapies and talk therapies are very important, as are a willingness to open oneself to seeing their own flaws and trusting others to help them change.

- One is physically or mentally impaired. This would include various impairments from using drugs or medications, poor nutrition, poor lifestyle, poor exercise. In some cases, there are public resources to assist those with impairments. In other cases there is widespread prejudice and stigma, and active discrimination. Finding what supports exist and limiting the demands of the discriminating people is important.

- One's brain is damaged. Maybe you do have a chemical imbalance, or had an injury to your head or nervous system, or have a genetic condition affecting your brain. In these cases all of the above are relevant, and medication may be an essential piece as well.

What is mental illness?

As a final note, let's define mental health and illness. I've said mental illness is caused by chronic distress, but what is mental illness? Is it being "out of touch with reality"? Well, no, actually several studies have pointed out for instance that depressed people are more objectively realistic than non-depressed people. Is it being "normal"? Well, that's a rather fascist viewpoint, and ignores ideas like cultural relativism. It's hard to define, and sometimes is very problematic (was it mentally ill to reject Nazism if you lived in WWII Germany?) Okay, is mental illness the absence of positive feelings or the presence of "excessive" negative feelings? This is also problematic and fuzzy. Certainly one tripping out on Ecstacy is not temporarily much more mentally healthy than someone pushing through enormous pain to finish running a marathon. When we experience heartbreak at loss or grief at the death of a loved one, we aren't ill, are we?

It's curious that these terms have been so difficult for people to define historically, when in fact the concepts of health and illness are relatively simple. Health is a state of fitness. Someone who is healthy is able to handle more challenges, more stress to their system. A healthy person overall is more capable than that same person when they are ill, because illness, unhealth, is impairment of functioning. If you wear a chicken suit to the office every day, but are well liked and perform your job to high standards and are not otherwise suffering any loss of ability to adapt to what life throws at you, you are not mentally ill simply because you are not conforming or are odd. Likewise if you think you're better than everyone, are constantly insulting others and pointing out their failings to meet your standards, drink every night to take the edge off and occasionally blow off some extra steam by beating your wife, well, you aren't healthy. Again, not because you're not conforming, and not because you experience negative emotions, but because you are not able to handle a lot of challenges, and in the long-term, you are very likely to fail among society by not having as many resources socially, financially, (and possibly liberty-wise) as others.

If a pill makes you feel better, great. If it makes you more able to do your job, get along with others, or undertake therapy, fantastic. Now, figure out why you were having trouble functioning, why you felt so low. Investigate it. Work it out. Do the work required. Your mental health depends on it. Otherwise you're just another drug addict, and you're contributing to the ridiculously expensive cost of health care for the rest of us.

thanks for that.

I didn't read all of it yet cuz its too long - suffice it to say that what I glanced at, I understand and believe. (but will read later)

Peter Breggin is something of a brilliant martyr in this regard, pushing forth similar ideas.

A big problem with ANY antipsychiatric view involves the SEEMING LACK OF REAL, WORKABLE ALTERNATIVES out there. Most likely therapeutic models exist (Breggin himself documents cases in which he helped supposedly hopelessly psychotic individuals back to a state of stasis, but a VERY LONG, ARDUOUS AND of course EXPENSIVE process), but not in any real, or accessible way.

This big problem forks into 2 bigger problems:

1) the 'patient's' experience: ok, so I am one of those people who think that 80% of those wonderful, groundbreaking psychiatric diagnoses are b.s. parodies of actual acute mental disorders, but people do suffer actual, acute distress. Hallucinations, mood swings, lack of control, etc etc all SUCK. Who wants to live like that? Once again, what exists out there to help people through this stuff? You do what you can, even if it does more harm than good, even if that last bastion of self-preservation inside you screams "this is b.s. - this is unhealthy and counterproductive"

Possibly the main reason so many end up in shrink's offices is due to that phenomenom "when you laugh, the whole world laughs with you; when you cry, you cry alone". NOBODY wants to deal with someone in weird, unpredictable, chronic states of distress. Hence the proliferation of psych diagnoses and a happy smile for pharma (yipee!! more consumers!!)

2) the 'patient's' 'loved ones': Breggin speaks of parents angrily confronting him re. his beliefs as if he were an abortionist in a Bible Belt clinic. A recent excrutiating article in "Mother Jones" speaks of those parents who almost singlehandedly have kept Matt Israel's ATROCIOUS mental health/gulag institution alive over the past 20 years. (look it up, dear: Matt Israel in Massachussets. I can't link)

Why? are these parents sadists, mad, or both? No - simply, how do you deal with an out-of-control relative/spouse? Life's hard enough without having to deal with violent, explosive, unresponsive people. Once again, these people do the only thing they can, the only institution that affords ANY sort of relief, even if this relief's only in the form of coercion, sedation and, essentially, crowd control.

the other aspect of this are the legions of people helped enough by meds and psychiatry (IE, reasonably functional life) that the endless doctor visits, the uncertainty of psych's science, the life-long label, and the grotesque side-effects seem like a bargain in comparison to the alternative. Once again I state, I AM A BELIEVER. I BELIEVE THERE'S A BETTER WAY, and that every single one of these legions would VASTLY PREFER THE ALTERNATIVE were it to appear.

Nothing short of a different society, where human relationships took precedence over status and money, where a small family unit or larger community's VERY SURVIVAL didn't depend on SACRIFICING human relationships to status and money, where self--sustaining fishing communities were not daily victims to rapacious business fishing conglomerates (for example), would allow such an alternative to exist.

Matthew 13:9 "He who has ears to hear, let him hear."

Thanks of the post. You said some really good stuff.

It seems that some people, maybe 10-30% of people do great on medication with few side effects. Another third may be helped for a time, but do have to battle side effects and need to change their meds frequently. Then there is a bunch of us that do not get much benefit. It seems that the people who benefit, want eveyone to get on meds--they assume they work for everyone. Then there are people like me who believe that since drugs have not helped them much, that no one could be helped and no one should take pills.

I believe that the mind is like other organs. Some people have heart trouble, some have kidney trouble. Some of us have brain problems. Not everyone is the same.

In my case, I see mental illness as a way to avoid stress. I can only take so much, then my mind shuts off and puts me in depression.

James

A pretty comprehensive summary of the history and current state of psychiatry/psychology.

It's very sad to think of all the people who have turned to 'experts' for help with their mental health, and been misled. However innocent and well meaning those 'experts' are/were, it's taken me about 20 years of dealing with them to realize that..however innocent and well meaning...they must posess a certain amount of arrogance to do what they do.

Peoples minds can be fragile things, and they are particularly fragile when people ask for help. They are not in the best position to discern between one treatment or another, one medication or another, or for that matter, one professional or another. They put themselves in the hands of a 'professional' who is doing their best to diagnose and treat a tremendously vulnerable individual without much more than anectdotal 'evidence' of what works and what doesn't.

Diagnosis is a crap shoot. Nonetheless they prescribe counseling or meds that cost the patient dearly in terms of time and money.

When prozac came out, there were allegations that it caused suicide. I don't think the medication caused the suicides that occured as much as the dashed hopes and disappointment when they didn't work.

Seeking professional help is often a last ditch effort for those suffering; asking for help dealing with life in a way that most people (if not all people) seem to sail through.

Last ditch effort, do what's prescribed....and when it fails...what's left?

I did the self-help approach for 20 years before I sought help. I did prozac and counseling for awhile and things seemed to get better; then it didn't. Another SSRI, another counselor, good for awhile, then not.

Back then - 20 years ago - psychologists who couldn't prescribe meds might work with a GP, or in my case, my OB/GYN. People who are clueless about these powerful meds. They write a prescription, but don't prepare the patient for side effects, for the need to slowly increase dosage, or slowly taper off.

Long story short, about 4 years ago I decided I would get better - I was insistent with the docs, actively pursued professional counseling - I worked damn hard.

In the end...nothing. I've given up on most of it. Somehow I've got a year's worth of prescriptions, and I'm going to take - or not take - what I want.

I'm going to live my wierd life in my wierd way and accept it, live with it, embrace it. It's much better than hoping I can be different, trying desperately to be different....believing in experts that support my 'need' to be different, when maybe all along, they should have given me support to be who I am.

Jemini,

Quite an interesting post with some very significant posts. Can you cite some of your sources for studies and other research you have included? I don't doubt the accuracy of what you have written, but I like to read the sources in their context and look at the studies to find other variables as well.

Thanks,

N.

thanks for this post!

also joyless.. i am right with you..

weird is ok.
ghost

Thank you SO Much for this site forum. Being a member of the non-conformist, anti-psychiatry movement is very lonely. The worse thing that has ever happened to me in my life was not child abuse, but psychiatric abuse. With child abuse, everyone feels sorry for the victims. With psychiatric abuse, you are rejected, reviled, scorned and yes, persecuted for speaking out. The most horrible thing you can EVER do to a person is to put a label on them and be judged forever. Any wonder we don't get anywhere with this movement? The resistance to the ideas expressed in this forum is enormous. People NEED to profile, judge, catagorize and label others to CONTROL them so THEY are comfortable. It is the NORMIES who need to be fixed--not us. As I have often said before: Who is really crazy here? The doctors forcing ECT on the patients or the patients? What kind of normal $#%^ is this to forcibly put electricity through someone's brains? These people are DANGEROUS! They are sociopaths. I once had a therapist who had the guts to tell me that she had met sociopaths passing as counselors in the mental health profession.

The folks who are a part of the anti-psychiatry movement are so brave and courageous. It is often a thankless and frustrating job to try to get folks to "see the light."

Thanks you ALL for your courage.

I am a HUMAN AND SPIRITUAL BEING. This is the ONLY label I will accept.

marylou wrote:Thank you SO Much for this site forum. Being a member of the non-conformist, anti-psychiatry movement is very lonely. The worse thing that has ever happened to me in my life was not child abuse, but psychiatric abuse. With child abuse, everyone feels sorry for the victims. With psychiatric abuse, you are rejected, reviled, scorned and yes, persecuted for speaking out. The most horrible thing you can EVER do to a person is to put a label on them and be judged forever. Any wonder we don't get anywhere with this movement? The resistance to the ideas expressed in this forum is enormous. People NEED to profile, judge, catagorize and label others to CONTROL them so THEY are comfortable. It is the NORMIES who need to be fixed--not us. As I have often said before: Who is really crazy here? The doctors forcing ECT on the patients or the patients? What kind of normal $#%^ is this to forcibly put electricity through someone's brains? These people are DANGEROUS! They are sociopaths. I once had a therapist who had the guts to tell me that she had met sociopaths passing as counselors in the mental health profession.

The folks who are a part of the anti-psychiatry movement are so brave and courageous. It is often a thankless and frustrating job to try to get folks to "see the light."

Thanks you ALL for your courage.

I am a HUMAN AND SPIRITUAL BEING. This is the ONLY label I will accept.

Couldnt have said it better myself

Good post jemini. Those are a few good points against psychiatry. Sadly, many people will not take time to read and research why psychiatry has flaws and the drug companies will embellish the positive outcomes of drug use for mental illness. Again this is why I want psychologists to be able to unprescribe medication. Hopefully I'll be able to help change that sometime in the future. Psychiatry has flaws like everything else but I think people just don't want to do anything about it like many things. I skimmed through most of the second part of your post but the only thing I found controversial was about Freud. I think saying Freud loved cocaine is a bit embellished. Other than that good post and thank you for sharing