Monday, May 13, 2013

Can Psychiatry Ever Really Get Rid of Stigma?



We all think stigma with mental illness is a bad thing.  Because mental disorders are stigmatized, people hide their psychic distress and don't get help, or they live in denial about their problems when the fact that they are mentally ill is obvious to others.  People live in pain, or they simply don't live up to their potential.  Stigma is only part of the problem, of course.  There is also the issue of access to care, access to good care, cost of care, dislike of the care that exists (mean psychiatrists, side effects from medications, lousy food or uncomfortable beds on inpatient units), and the fact that sometimes people lack the insight to be aware that they have a problem.  

Insurance companies, I believe, add to stigma, not because they want to stigmatize patients, but because this is a vulnerable group of people where they can avoid shelling out money.  Inadvertently, however, policies that exclude mental disorders or reimburse them differently, increase stigma.  Whatever the intent, the result is the same.

Some people like to compare mental illnesses to diabetes or hypertension: it's chronic, it's biological (we believe), it's an illness to treat like any other illness.  It's a lousy metaphor for a number of reasons: we don't know the biology behind the disorders, and psychiatric disorders are not predictably chronic.  Okay, actually, some people can get rid of their hypertension with weight loss, and then the disorders don't actually exist, but somehow once you're labeled with diabetes, it sticks (diet-controlled, even if you're not on a medicine, even if your blood sugar is normal).  

But aside from issues of insurance parity and certainty about the biological causes of psychiatric disorders, there is a reason I think that untreated or unresponsive mental disorders will always have  stigma.  In the world of "Reduce Stigma," this is going to be the totally politically incorrect thing to say.  Psychiatric disorders come with stigma because people in the throes of certain psychiatric illnesses sometimes behave in distasteful, frightening, unusual, and disturbing ways.  I think we've done a lot to decrease the stigma of depression and anxiety, and it's been immensely helpful that famous, brilliant, successful, beautiful, rich people have talked openly about their struggles with these disorders.  And while I think we've made progress identifying other disorders as problems/disorders/illnesses and not the 'fault' of the person, if a psychiatric problem makes it such that a person refuses to bathe, or becomes loud, irritable, and irrational in the work place, then no amount of reduce stigma campaigning will make it so that people will want to be next to someone who smells bad or whose behavior is erratic.   I, too, want to see stigma reduced.  But if someone is running down the street naked screaming about aliens, they have a bigger challenge to face than the person who quietly sits in the doctor's office and learns their blood pressure numbers are over a certain level.

The answer?  Better treatments, of course.  And more success stories from those with major mental illnesses.  I remain hopeful.

37 comments:

jesse said...

This is an excellent subject to explore and hopefully there will be quite a few replies. Dinah, I both agree and disagree: there is certainly more stigma for mental disorders, and I don't think it will ever diminish to the point where it is equivalent to other physical illnesses. The reason, however, is not just that some disorders lead to rather bizarre social behavior, although that certainly does not help.

No, it is rather that we humans can easily acknowledge that our hearts, skin, eyes, have physical diseases because they are exactly that: our eyes, our skin, our hair, and so on. On the other hand our minds (as distinct from our brains) are "us." We preceive our minds in a very different way from how we perceive the rest of the body. There is something immortal, detached, existing on its own.

So we don't like to acknowledge that there is almost anything amiss with that "us." It is extremely threatening, much more so than the fear of diseases of the rest of the body.

That the mind actually is a product of biological processes and does not exist apart from them is a concept that might have lead one to be burned at the stake at one time.



Dinah said...

Then Jesse, how do you explain that there are mental disorders that are fashionable, that come with almost no stigma. Attention deficit disorder, or it's sibling ADHD, implies there is something fundamentally wrong with the brain, you are wired so you can't sit still, can't focus, can't learn quite right, and yet it's a DESIRED diagnosis...it gets you stimulants, extra time on tests, and students talk freely about "I have ADD." A physician parent once said to me "I paid $1,700" so John could get extra time on tests (what neuropsych testing costs). John, by any casual observation, was a high-achieving, smart, focused kid (and John did, indeed, get into a very competitive college). When I was in school in New York, people talked openly about going to therapy, there was no stigma, if anything it was a culture of "the unexamined life is not worth living." So it's not just the concept that it's unacceptable for the mind to not work.

And I do think there is some stigma to having physical problems. They connote weakness, imperfection, and vulnerability, and if they are associated with behaviors, then the victim of the illness is blamed for them.

jesse said...

Conditions such as ADHD are not seen by the public as "mental illness" and are today rather fashionable. "You are SO bipolar!" said in the way in which everyone in my day was "SO neurotic." We know these conditions are mental illnesses but they are fashionable only to the extent that
the people who are so described are on the much less sick end of the scale.

But more to the point I was making, those illnesses are not seen as destroying the "self" in the way that the severe mental illnesses do, such as the depression Allie described so poignantly in her blog Hyperbole and a Half that was linked to earlier.

Liz said...

i'm a success story- from the state psych hospital to graduate school- i've successfully navigated suicidal depression and work my tail off to stay well in spite of difficult circumstances. that said, i still feel the stigma. i recently had a baby, and the first thing the pediatrician said to me at the first well baby visit was, "you're bipolar, so..." and proceeded to question me regarding my symptoms, management, etc. the only reason she knew about my diagnosis was because it was on my chart from my ob-gyn for a variety of reasons. while my health is important, i imagine if i was diabetic that would not have been the first thing out of their mouth. it is situations like this that make people who have recovered or are managing really well keep their mouths shut about their diagnoses. i wish i could have!

Steve Curran said...

The more we share our stories of living with a mental illness the more awareness we create. Talking about living with a disease puts a "face" on it and usually changes people's perception of mental illness.

We need to talk about healthy living!

mctps said...

I feel like agreeing 100% with Dinah here. In the same breath, I have experienced strange things that are difficult to perceive as mere products of my own mind. Adam Crabtree wrote that other psychotherapists sometimes sent their patients to him when they exhibited symptoms that disturbed even the psychotherapists, I'm assuming partly in the sense of being inexplicable like some cases of multiple personality.

I think the problem for some schizophrenics is that, even though sanity is alluring, and sometimes you feel like you can forget what you've experienced, and you tend to think of yourself as mad, still .... you can't find very convincing rational arguments for discounting some of your wild theories about mind controlling quantum computers or whatever. And if you are functional, non-threatening, and have work, a lot of people might not even think you are ill. Charles Fort thought that there existed a force, which he called X, that was able to cause hallucinations in humans as well as control their minds so subtly that people weren't aware of any influence, yet their behaviour was crucially modified at crucial moments or perhaps throughout life. So if even an apparently healthy and extremely intelligent man like Fort could believe in such things, why not lesser men like me, without being labelled sick? Thing is, the existence of such a system is possible, for all we know, and a Darwinian universe would probably, at some point, produce a hidden elite and a slave class of that kind. Perhaps that point was reached in this part of the galaxy a long time ago. This would explain the origin of our concepts of God and Satan. The thought doesn't even scare me or disturb me, I'm so used to it. I've also enjoyed my supposed illness more often than not, because I have an amusing and very intelligent voice in my head, and for other similar reasons. My depression has also been gone for the past several months, and didn't last more than a year anyway. So I feel like I've been reasonably well treated by X, if that's what it is all about.

Well, right now I can't write a better message about struggling with "insanity". For me it has been mostly intellectual, even if I've also had clear periods of what I'd call psychosis for lack of a better term.

I feel like it's a mistake to write messages like this to people who are either blissfully ignorant or correct that I'm merely insane. But there did seem to be an interest here in accounts of people living with serious mental illness.

Anonymous said...

Perhaps mental health professionals need to look at their attitudes about their clients first before blaming society regarding the issue of stigma:

http://beyondmeds.com/profpatient/

Monica Cassani, a former social worker who tapered off of 6 psych meds after being in the mental health system for years, talks about how when she identified as a user of the system online, she was treated in a totally different manner vs. when she simply identified herself a former social worker.

"I’ve seen this on twitter and before that in email groups. The most disturbing place that this has happened is among professional groups in which I’ve revealed my ex-patient status. Even in professional groups who at least in theory profess and share my interest in radically changing the system and using alternatives to psychiatry is this bigotry present. Not by all the professionals of course but depending on the group whether it be alternative or mainstream mental health professionals anywhere from 50% to 80% I’d say are dismissive of me when I identify primarily as lets say, the author of this blog. This in spite of the fact I will include my professional history as well. It’s clear what people remember though is that I was a user of psychiatry. A mentally ill person, I guess. (I don’t consider myself such but that doesn’t seem to matter even among those professionals who profess to not believe in mental illness!!)

When I am not the author of this blog and only identify as clinician and/or social worker I am received with a respect I do not receive as author of this blog. I am also engaged more deeply and with more interest.""

roblindeman said...

"[I]t's biological (we believe), it's an illness to treat like any other illness. It's a lousy metaphor for a number of reasons: we don't know the biology behind the disorders..."

Here, in brief, is the problem with biological psychiatry. "We" (by which you mean "YOU", not "ME") believe these disorders are biological. And yet we have no biology before us. Until such time as biology appears, I will remain a skeptic that it WILL appear. It's not like y'all haven't been trying.

"Psychiatric disorders come with stigma because people in the throes of certain psychiatric illnesses sometimes behave in distasteful, frightening, unusual, and disturbing ways."

Well said. This is precisely why we treat individuals with so-called mental illnesses badly. It's why we get away with coercing them to take medications and it's why we get away with incarcerating them without due process of law.

jesse said...

One of the best things about Shrink Rap is the cross-polination of thoughtful comments. So here is a revision of mine:

Stigma against mental illness will disappear when the symptoms and illnesses themselves disappear or at least are easily treated by means that have no unpleasant side effects. So they will be regarded as we do an occasional nighmare. We no longer walk around with fear of the Black Death, for instance, and few can tell what it was. So perhaps before long there will be a conversation like this one:

"Johnny, did you put on your Mental Illness Gene Revision Patch (MIGRP) that the nurse gave you? It completely prevents mental illnesses. You need to use it for two days."

"But what are mental illnesses, Dad?"

"Well, I've only read about them. there was one called schizophrenia. People got it back in the days when the earth was cooler and cities did not have to be covered by domes to get rid of carbon dioxide. It led people to respond more to what their minds created than to reality."

"Wow, back when the earth was habitable? But why did people ignore for so long what carbon dioxide was doing? Was that schizophrenia or some mental illness?"

"They didn't think so at the time..."


Richie said...

My boss is loud, irritable and irrational. He tends to dress well and wears expensive cologne but his cigars stink. He is a billionaire and no air of stigma attends his bad behaviors.

Dinah said...

Liz: congratulations on the baby and the success story! It seems reasonable for a pediatrician to inquire about depression in a new mom, but it should be done in a caring and respectful way. I wondered if maybe the pediatrician had a psychiatric disorder and was more interested, or maybe a story with a bad outcome which can overly sensitize docs. It seems fine to cut the conversation short with, "Thank you for asking, and I'm doing well." if that's the case.

Rob: you don't believe psychiatric disorders will be found to have a biological basis but you don't know that.

I can imagine that mental health professionals are just as susceptible to stigma as others.

I think part of the issue is how well do you get when you get well? So Kaye Jamison and Elyn Saks talk about their illnesses, but they still command respect.

And Richie, I will stigmatize your boss. I get sick at the smell of cigars, don't like thick colognes, and I don't want to sit next to your boss.

The erratic issue is probably what triggers the thoughts of mental illness. If you're always loud and belligerent, you may just be a jerk. If you're normally pleasant and wonderful then suddenly stop doing your usual activities, withdraw and become irritable, you get to be something other than a jerk.

I will point out that there is more hope for those with psychiatric disorders than for jerks.

Jesse--adorable. Now put your patch on.

Larry Melidis Siskin said...

my attitude towards the stigma is simple... we have to go out and give the whole picture...
it is probably the brain that plays tricks on the mentally ill patients and those tricks can be anything from anxiety to hearing voices, seeing things, being euphoric and flamboyant to hopelessly depressed. this is the truth, most mentally ill patients are very peaceful and if anything they are a danger to themselves and not to others. why is that a trick of the brain cause stigma? it should be as embarrassing and worthy of joking as an uncontrollable bladder.
so lets say it out in the open educate the public. the aim should be to one day be able to joke about it.

jesse said...

A lead article in the NY Times today tells that Christine Quinn, speaker of the City Council and a mayoral hopefully, is talking about her bulimia and alcoholism, for which she went to rehab at 26. Clearly increasing openness is a big part of acceptance and understanding.

roblindeman said...

Dinah, I said nothing of the sort. I said that until such time as biological causes are found, I will remain on the sidelines.

If I had lived in the early 20th century when Treponema pallidum was isolated, I would not have believed that tertiary syphilis caused madness. But Treponema pallidum WAS discovered and now I believe it.

It's true I don't know that (some? all?) biological causes will be found. Until then, it does no one any good, particularly suffering people, to pretend that there ARE biological causes. And it's worse to make up cures for the sake of "just doing something".

Anonymous said...

Thank you for writing this! I feel more human. I had a consult with a urogynecologist recently for a problem no one else could diagnose. He remarked how well prepared I was for the discussion with three professional journal articles and a typed agenda. Before prescribing a new script, he went down my med list. Stopped short when he saw the lamictal. "You don't have a seizure disorder, do you?" "No, I have bipolar disorder." "You can't, you don't act like one." Ta-dum.

Anonymous said...

I doubt psychiatry will ever get rid of stigma because the stigma around mental illness is firmly entrenched in the medical field. Every time I renew my license I have to answer yes or no to the following question: "Have you been treated for any of the following mental illnesses within the past 5 years: Bipolar disorder, schizophrenia, other psychotic disorder, borderline personality disorder, antisocial personality disorder..."

Luckily major depression and anxiety are not on that list or my career would be in trouble. It's not right that people who have not been in any trouble at work or committed crimes should have to answer that question. If I'm doing a good job at work, then no one needs to worry about my diagnosis. I live in fear that one day I might get tagged with one of the diagnoses on the list and then I don't know what I will do. I know I will not lie on a government document, but I also will not turn over my medical records to a state board when I have done nothing wrong and not endangered anyone. Stigma is alive and well and I feel it, particularly within the health care field. Society needs to stop penalizing people for seeking help and trying to make things better. This is why so many people who work in the health care field (and are licensed) do not dare see a mental health professional. They do so at a risk.

Joel Hassman, MD said...

Hey Rob, explain your interpretation of delirium to us, just so we understand what you mean by biological mechanisms to psychiatric disorders.

Yeah, I'll give you that delirium is a medical cause to psychiatric symptoms, but, tell the people on the receiving end that their family member/loved one/friend who is acting psychotic, depressed, or cognitively impaired is just having a bad day! Oh, and why do some psychiatric meds have some impact until the medical condition is treated?

Now, tell us how schizophrenics seem as a group to respond to medications that alter dopaminergic actions, and then tell those loved ones watching the hideousness of psychosis their loved one is having a bad day.

Finally, Rob, tell my patient who has failed numerous med trials and is profoundly depressed and psychotic that an intervention like ECT is not at all a biological intervention with a likelihood of impact for improvement, and he should entertain putting that shotgun in his mouth!

Yeah, you know why I wrote my post last weekend about why antipsychiatry is just as bad as psychiatrists who solely embrace medication models, because the mirror image is of your enemy.

Polarization of issues doesn't sell hope, just division and hopelessness. And your example above doesn't support your point of view. It took a while to find out about spirochetes. How long did Newton get repulsed by the powers in place?

Long time I bet!

BLC said...

In regards to Dinah's early comment, that surprised me that the kid needed neuropsych testing just to get extra time on tests for ADHD. Typically, just the diagnosis of ADHD, no neuropsych testing required, will get you extra time. If he needed psych testing, that indicates that the parent was looking for some kind of learning disorder. Maybe requiring neuropsych testing is specific to Maryland? The only other thing I could think is that the parent could not get an ADHD diagnosis, checked that the kid's processing speed was low on psych testing, and buffered her case. Though if the clinical interview didn't support ADHD, I wonder if the kid had a processing disorder and that was why the scores were off.

I just thought that was interesting that the physician spent 1,700 dollars on an ADHD diagnosis when it's so easy to get one without neuropsych testing.

Dinah said...

BLC,
copied and pasted from the college board's website:

Documentation guidelines for extended time

Please keep in mind that a student's documentation must demonstrate not only that he or she has a disability, but also that the student requires the accommodation being requested. Therefore, a student who requests extended time should have documentation that demonstrates difficulty taking tests under timed conditions. In most cases, the documentation should include scores from both timed and extended/untimed tests, to demonstrate any differences caused by the timed conditions.

The following tests are commonly used to measure a student's academic skills in timed settings. Because tests are frequently developed and updated, this list is not exhaustive. There are other timed tests that may also be used. Tests must be conducted under standardized procedures.

Nelson Denny Reading Test, with standard time and extended time measures Stanford Diagnostic Reading Test (SDRT)
Stanford Diagnostic Math Test (SDMT)
Woodcock-Johnson III Fluency Measures
Test of Written Language-Third Edition (TOWL-3)

When these tests are administered under standardized conditions, and when the results are interpreted within the context of other diagnostic information, they provide useful diagnostic information about testing accommodations. A low processing speed score alone, however, usually does not indicate the need for testing accommodations. In this instance, it would be important to include documentation to support how the depressed processing speed affects the student's overall academic abilities under timed conditions.

BLC said...

In my part of the country you can get extended time for psychological conditions (anxiety, ADHD, etc) if you provide documentation from a doc (. And it doesn't require testing. They'll do anything if a doc backs it up. They will move you during final exams to the same room you were in for lecture if a doc says you can only take tests effectively if you are in the same environment that you learned the material in. That was just one random anecdote I heard.

Anyhow, interesting.

But there is also testing. And I swear any time someone's processing speed is unusually low, but the person is smart or at least of average intelligence, the first thing everyone starts talking about is ADHD.

roblindeman said...

Joel, you've missed my point. I can't explain delirium to you, and neither can anyone else!

The "bad day" argument is a straw man. I never made such an argument. My claim is simple and straightforward. So I'll try again to re-state, simply and straightforwardly:

One cannot claim biological causes to mental illness when one cannot show those causes.

Not straightforward enough. No, I can tell. How about an analogy?

In the 17th century, there were witches. (No they're weren't, you'll respond, everybody knows there's no such thing as witches). Everybody knew there were witches and it was pointless to argue otherwise. If someone did suggest otherwise, he might be met with the following snarky retort:

"Now, tell us how victims of witchcraft seem as a group to respond to exorcisms, and then tell those loved ones watching the hideousness of their demonic possession their loved one is having a bad day."

Yeah, but there's no such thing as witches!!!

Ok, fine. Go on and believe in them if you must. I'll wait until you actually produce a witch and we'll talk

Anonymous said...

Rob,

Obviously, you have never met my mother in law.

Nathan said...

I might also add that our historic treatment modes of mental distress add to stigma, even as they attempt to reduce distress. That people seek private consultation with a supposed expert to speak all sorts of thoughts/feelings/dreams/whatevers that they are told they should never say in their actual life, creates this dichotomous life, where our more lived/public ones are only for happy good times, while we bring our distress/fears/shame into a consulting room. Folks who are more open with their distress or seek support from non-professionals are met with bewilderment, fear, and their own anxiety of their own distress is activated by someone who is openly disregarding the unwritten rules that people are supposed to be always put together, happy, productive, and consuming.

I think by privatizing distress and distress treatment, as we do particularly with psychotherapy, actually adds fire to the power of stigma, as it unfairly and falsely locates distress in individual people and what they express in the unseen consulting room. Psychiatrists, by playing experts on people's mental health, play into this by turning distress-reducing into a profession, mediated by capital and hierarchical relations, as opposed to distress-reducing as a community value (everyone experiences distress and we can help each other in times of distress). By "hoarding" the power of expertise, mental health professionals strip lay folk from being effective and active distress-reducers in their own social networks, and we have seen, I think, a dramatic drop in people being able to sit with their own and others pain as those skillsets are now not being expected to have by lay folks. So now, when someone confides distress in others, the reaction is "go see a professional! (and if you keep acting weird I'm not going to know how to handle being with you, so you better get help so we only share good times again!)"

PsychPractice said...

Forgive me if I offend anyone. But even dogs will avoid people or animals they perceive as behaving erratically. I think there's got to be some "wiring" involved in staying away from people who seem psychotic.

Steven Reidbord MD said...

@nathan, you make an interesting point. But the roots of this sequestering of our "worst selves" far precedes psychiatry or psychotherapy. The Catholic confessional is one obvious example. More generally, shame keeps "family secrets" secret, and people don't "air their dirty laundry" or expose "skeletons in their closets". I'm curious if you're aware of other cultures where this is not the case.

In public most of us aim to put our best face forward, and to my knowledge always have. Intentional exceptions seem to be for artistic or political purposes, while unintentional exceptions, as in the case of some suffering severe mental disorders, are stigmas. In this larger context, it is easy to understand why the emotionally distressed choose not to publicize it, and why remedies are sought in private. Nonetheless I agree that sometimes this falsely and unfortunately places the ill in the individual instead of in the larger social unit where it arguably belongs.

Nathan said...

@Dr. Reidbord,

Of course individuating distress is not new, neither is capital mediated ritual for mediating distress (ex. mystery cults of the ancient Mediterranean and Scientology, and I don't think psychoanalysis is all that different from these endeavors in form and function). I think Catholic confession is a little different from more modern psychotherapy in that confession was supposedly available to everyone and not for a fee, and in context of a worldview where everyone is inherently damaged (so less individual shame for experience/committing what was considered sin). There are plenty of problems with such a worldview too.

So my issue is not that we live in a world where we privatize both the experience and treatment of distress, but that I think we have learned enough from all of these different media of distress reduction from across time and culture to be skeptical of why we continue to maintain the basic structure of privatizing that pain through arbitrary resolution structures (now the mental health industry). We pretend that we don't have "family secrets" and then stigmatize people whose family secrets become public (as opposed to being compassionate or helpful).

I do think Psychiatry, regardless of intent, helps to maintain stigma of experiencing/sharing distress due to its practioners making a good living on the privatizing of the experience and treatment of distress. So instead of maintaining that sense of secrecy, shame, privacy in distress, we should be building communal practices that don't stigmatize (and devalue) folks for experiencing distress (unless they can pay for treatment) but value the opportunity for help ameliorate it.

As I have come to realize in engaging with the science of mental health practice, belief in the theory of pathology it professes and the helpfulness of treatment provided is the key factor in ameliorating distress, regardless of the validity of the pathology. I think this is why the DSM5 controversy is actually controversal. The leaders of the psychiatric establishment have basically admitted that their understanding and hence treatment of distress has been built on falsehoods. This crisis of faith I would predict will reduce the helpfulness of treatment for a lot of people. This is sad, but at the same time, I do not think it is ok to continue to create false belief systems that profit financially and politically certain kinds of industries and clinicians to moderate our distress.

Joel Hassman, MD said...

"Joel, you've missed my point'. Really, what was your point, I think I got it clear, there is no justification to biological causes to mental illness, and there lies the foolishness in such a claim.

Delirium is a disorder that has no one specific cause, but it is relatively easy to explain, and I will summarize from Kaplan and Saddock's section about it for readers to digest:

"Delirium is "characterized by a disturbance in consciousness and a change in cognition that develop over a short...time". The hallmark symptom of delirium is an impairment of consciousness, usually occurring in association with global impairments of cognitive functions. Abnormalities of mood, perception, and behavior are common psychiatric symptoms; tremor, asterixis nystagmus, incoordination, and urinary incontinence are common neurological symptoms."

Oh, and for readers to know, in this day and age of quick fix and immediate gratification, providers act the same way, so, they don't want to entertain delirium as a cause of the patient showing psychiatric symptoms in a somatic bed, they just want the patient quieted quickly and sent to psych inpatient care if able. Calm and quiet 'em now, and give us a psych diagnosis.

Oh colleagues, remember in med school and residency, morbidity and mortality rates of undiagnosed delirium are 50% +.

Now that we have that explanation out of the way,

All I can say to your "One cannot claim biological causes to mental illness when one cannot show those causes." statement is what I noted prior: claim that a hypothesis has no application is basically asking us all to reconsider if prior claims like gravity, bacterial infectons, and pluto should be not only ignored but reviled and treated harshly with extreme prejudice until the proof was irrefutable.

That is the logic of an antipsychiatrist. Do you really want to condemn all who struggle with mental health symptoms because you don't like the treatment protocol? Not that I sell a meds only intervention, but really, do you want to continue to preach meds have NO role in care?

Careful what ya wish for, a patient might find out that antihypertensive meds have no applicability and refuse them per your rationale. Was that resulting stroke not a biological response?!

Probably due to that witch poking the pin in the doll's head!

Man, what my colleague said last week, "common sense is the exception". And people with expertise validate that comment!

roblindeman said...

Joel, I think some of your animus is directed against someone else with whom you are not arguing at the moment.

I'm not an anti-psychiatrist. I happen to be a big fan of talking therapies in general and analysis in particular.

I'm not even anti-medication. I've said at this blog and elsewhere that folks should be allowed to take what they want to take. But that's a different subject.

Here's what I'm against (Deep breath)

I'm against lying to ourselves and to our clients as to what these medications do and don't do. And I'm against coercing clients to take anything with the threat of incarceration or other deprivation.

And I'm really REALLY against involuntary incarceration.

There. Clear enough?

Joel Hassman, MD said...

Fine, thank you, my apologies for misunderstanding your earlier comments. I have to say though, I thought i read you say at another site, or a prior post here, how you feel there is no place for psychiatry. Maybe if your see all of psychiatry just medicating, that seems to support your position as above now, but, I wish i could say that is my interpretation of your comments.

Again, sorry for the aggravation.

Joel H

roblindeman said...

Don't apologize for being defensive. It's natural to want to defend psychiatry, particularly if it's how you get paid.

Now, I'm a critic of medical practice in general and a vicious critic of my own specialty, Pediatrics, in particular. But I'm led to believe that this is not the norm.

Anonymous said...

Stigmatization of mental illness is a recurring theme on this and other blogs.

I am a successful woman in my mid 30s, previously derailed by bipolar (II) disorder, and currently a graduate student in a highly competitive professional academic program that trains individuals to be decision makers in the health care field. Incidentally, I also earned a PhD in a Biomedical Science prior to my BP diagnosis though I was diagnosed as depressed.

I am open about plenty in my life.
I remain in the closet about my psychiatric diagnosis.

jesse said...

@Rob: we understand very well what you think about medication and any form of forced treatment. You posted this, "I happen to be a big fan of talking therapies in general and analysis in particular. ."

I for one would be very glad to hear ideas, comments, questions, whatever about the talking therapies and analysis. There are too few people engaged in dialogue about these topics. Please write about them! I think you have a lot to say.


TomTom said...

The talking therapies and analysis made for some good movies and HBO. Meds are too boring for that. Watching some guy pop his pills is dull. Watching some guy shoot up is less dull but you need more drama, blood and guts and a dead body. With talking therapies, you can make the same movie over and over and people will watch.

Anonymous said...

If psychiatry as a whole wants to reduce stigma, it should stop promoting the entirely unproven biomedical model of mental illness, since every study done on the subject shows that such a model increases stigma.

Also, stop depicting the mentally ill as running down the street screaming and naked, or as smelling bad, or as anything else negative, and start depicting the mentally ill as the graduate student anonymous commenter.

Nathan said...

So with you, May 17 Annonymous

Anonymous said...

The problem, really, is that mankind is not a learning animal. They will never stop throwing the first stone, or if not the first, the second, and so on, and on and on. They lack empathy, because they lack understanding, because they lack eyes and ears, because they lack the divine spark or it's been muted by televitz or by some disease that can't be seen.

Was Christ mentally ill, as has been suggested recently, or did he get something these mental health professionals tend not to get?

Don't throw the first stone. Drop it! You don't understand.

Anonymous said...

There's a fine line between being less than life because you're crazy and being larger than life because they say you're crazy.

As a witness, what you get out of other people's "madness" depends on what you make of it. We could have made more of Christ's for example, if he was mad.

Encountered the below message somewhere else. Imagine the richness of what would've been lost if it could never have been written:

Funny how the tortured become the councilors for the ones who commit to doing the evil and deny it so wholly though they all quite know by now; and there is no denying it, not without a miracle here or there. Wouldn't you think they figured something out in the future? Maybe not. Maybe it fails and the beacon goes dim and people forget for another 2000 years etc. But not thats not what it is; I know I can see the future; from time to time.

Time changes fast now.

They have the gun and toys these talking monkeys and their security, they are made of flesh and pre-rendered mammalian bestial impulse cut with digital jazz programming- illicit constructs, petri dish anomalies, the best in the galaxy I would only hope.

DO NOT FUCK THIS UP.

They speak without words and weave the causalogical chain- the body is what we cling to in denial of the truth, this is why its necessary to

Come out to show them...

And come out to show them...

Come out to show them...

And they will, and they have, and it has been done and they and it, and those, and the other; within this matrices of organismic symbiotic tapestry exists a harmonic gestalt a divine propensity from mind to mind all self similar; corroding away the structure leaving the wake of imagination to collapse upon the shores of reality.

The fear is your controller. Better to die fearless and know where you are going than to die as a coward trying to protect what is impermanent and fleeting- the nature of life and the corporeal body.

They like us are commanded by light. They just don't know it because they have become obscured from their true nature- that they like us are commanded by light.

Satan has you! do nothing and all he has is a penchant for grasping that and failing- and falling further into the place he has created. You should have sympathy for him, because his ignorance is so great as is to create an empire of darkness larger than time, but less than it, an obfuscating vehicle of temporal entrapment. But the world of matter and form is his domain, of course he wants us here in his system, he is like standing by the door trying to tell you he is repairing the hinges or something and it will take a while- then you realize the door doesn't exist and neither does the prison- that they like us are commanded by light.

And begrugingly he must accept this, and knows this is true absolute truth- and his friction against the process is no crime- only the necessity of creation itself to fulfill its own nature of existence as such.

Its all there- in fragments of the holy books from the different tribes- before unification.

Can you remember the future?

Then come out to show them...

They like us are commanded by light.

or they are non-existent and are unknown and only through absence. Which is neither or any.

Remember the future- and come out to show them...