Thursday, March 23, 2017

Chapter 4: The Horoscope Doctors

(in progress)

Both as a theoretical construct and a system of classification, the disease model of mental illness leaves much to be desired.  Unlike other medical disciplines, there is no proven etiology for specific disorders. Despite millions of dollars in research, there are no detectible viruses, bacterium, neurotransmitter surpluses or deficits, hormonal surpluses or deficits, organ malfunctions, genetic abnormalities, injuries to bone or tissue, nutritional deficits or the like. Instead, mental health providers base their judgments on clusters of phenomena that, to them, seem to go together.

In this regard, the DSM operates far more like your newspaper horoscope than legitimate science. Instead of observing the movements in planets and stars, clinicians are observing clusters of mental and bodily developments.  When certain phenomena emerge together, they make predictions about your current status and future needs.  (This gives new meaning to the phrase: "I need to look in your chart.")

Just like astrology, the clusters and their associated ramifications have a lot of intuitive appeal that seems to ring true for some people.  Unfortunately, the general patterns aren't clear enough on a broad population basis to yield a reliable picture of what is going on underneath the surface.  You might as well say, “I’m a libra” as “I’m bipolar.”  They both tell you about as much about yourself.

As a result, these categories hinder efforts to develop treatment approaches that provide verifiable, consistently satisfying results.  Given the current outcome data, the average person might do about as well consulting the stars as by following the treatment plan developed by a licensed mental health provider.

Adding Insult to Injury


Add in conventional prejudice around the 'mental illness' labels, and it gets even worse.  It's like your provider looking only at your horoscope and taking that as the end all and be all of what is happening in your life.  Pretty soon, family, friends and everyone else you know are following the provider lead. Next thing you know, all of your complaints are seen and interpreted through the lens of your horoscope. Other issues you're having -very real ones - aren't taken seriously, because hey, "the moon is in the 7th house and Mercury is aligned with Mars, so what do you expect will be happening in your life...?

The simple fact is a lot of us are grieving real life losses - the loss of jobs, careers, community standing, financial security, family roles, spouses divorce us, courts take our kids, friends abandon us, neighbors look the other way.... These losses all too often follow and directly result from - not just precede and 'cause' - a psychiatric diagnosis.  Yet our very real pain is minimized or dismissed.  Everyone knows that people with our horoscope [diagnosis] can't expect much.  So probably we don't feel much either....

Arbitrary Privilege


The arbitrariness of the medical model has yet another disturbing dimension.  As a practical matter, there are countless non-disease approaches that people use to make sense of the experience and guide their approach to life.  Many of these approaches have – or may have - similar reliability, validity and outcomes as conventional mental health.  There are personality measures like the Enneagram and Myers-Briggs that describe common themes in human behavior and that many people find helpful in understanding and relating to others.  There are practices like acupuncture, naturopathy, reflexology, reiki, cranio-sacral therapy, massage, yoga, meditation, chiropractic, osteopathy, art, coaching.

Practitioners of these and similar modalities can reasonably claim to offer both mental and behavioral benefits to people in distress that – dollar for dollar – would be just as efficacious and far more enjoyable than traditional mental health treatment.  Like psychiatry, these alternative modalities all claim skill at:

  • identifying the causes of human distress, 
  • remedying existing problems, and 
  • preventing potential future catastrophes 
for individuals and/ or their loved ones.

Moreover, if vested with the research dollars and sophisticated methods available to the Pharmaceutical industry, quite possibly many alternative approaches could demonstrate efficacy equal to modern psychiatry.  This is not an exaggeration. The fact is, armed with the resources, tactics and scope of influence available to Pharma, quite possibly  phrenologists (who measure skulls), fortune tellers (who look at the lines in hands), and reflexologists (who track the patterns in feet) would all by FDA approved and Medicare re-imbursed. The 'science' is just that slimy.  

Seen in this light, the bias toward medical methods and interpretations is alarming.  None of the non-medical alternatives come close to enjoying the public standing granted to medical model providers. They rarely if ever qualify for government research grants, private insurance or public reimbursement.  They never get to force their recommendations on unwilling subjects.  And they certainly don’t get asked by courts to opine whether someone should lose their freedom based on yesterday’s horoscope or an overly long toe.

Chapter 3: Medical model outcomes

(in progress)

If you want to understand the problems with medical model outcomes, the definitive sources is Robert Whitakers work and website, MadinAmerica.com.  This is really the most careful and comprehensive analysis of the research to date.  Bob's work is so thought provoking and persuasive that, in fact, it has convinced many career psychiatrist of the urgent nice to rethink these issues.

Since no one makes the case better or more clearly than Bob, I refer you to the parts of his work that, for me, have been the most personally illuminating.

Resources:  





About

Chapter 2: Social Determinants of Behavioral Health


An estimated ninety (90!) percent of those in the public mental health system are ‘trauma survivors.’ We have grown up without reliable access to same basic needs that the United Nations recognized as essential over six decades ago.

The same applies to the other so-called ‘problem’ groups in our society.  Yep, ninety (90!) percent or more of us in substance use, criminal justice, and homeless settings are ‘trauma survivors’ as well.
This is not just about individual needs, but also family needs and the needs of entire communities. These issues affect all of us across demographics.

Don’t believe it?  Check out the following:



Yet, for all the fanfare about the need for more ‘trauma-informed care,’ there has been little systemic response directed toward basic human needs.  Equally disturbing, behavioral health system involvement has become an independent, exacerbating source of harm for many.
The results speak for themselves.

Resources:

Boisvert CM, Faust D  (2002) Iatrogenic symptoms in psychotherapy: A theoretical exploration of the potential impact of labels, language, and belief system. Am J Psychother. 2002;56(2):244-59

Cassani, M (August 9, 2014)  Treatment resistant mental illness? or Iatrogenic (drug-induced) illness?, https://beyondmeds.com/2014/08/09/treatment-resistant-mental-illness-or-iatrogenic-drug-induced-illness/ (and resources cited therein)

National Council on Disability (January 20, 2000), From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves, http://www.ncd.gov/rawmedia_repository/21553992_2d13_4dcb_a1c4_ee6c9e9434e8.pdf

Chapter 1: Defective Theories of Mental Defects

(in progress)

In reality, life is often hard.  There are a lot of troubling experiences to make sense of, both outside of us and inside of us.

Historically, there have been varied explanations for human behaviors that defy explanation. Theories include possession by demons, divine displeasure, the imbalance of the bodily ‘humours’ (blood, yellow bile, black bile, phlegm), bad genes, dysfunctional families, repressed sexuality, maladaptive learning… The list goes on.

Then there was ancient version of the mind-body debate.  Aristotle believed the heart (body) was the source of human emotions and intellect.  Hippocrates saw emotions and intellect as properties of the brain (mind).  

In Western medicine, Hippocrates won out.  He piloted the brain theory and the disease approach to mental inexplicabilities.  In modified form, his theory still holds pre-eminence today.  

Modern Hippocratics


The modern understanding of the ancient Hippocratic paradigm is articulated in two separate, but overlapping models.  These include (1) the mental disorders described by the ‘DSM’ and (2) the medical model of ‘mental illness’.   Both models have significant practical, theoretic and empirical limitations, as we point out below.

1. The DSM Model of ‘mental disorders’


The DSM Model is based on the Diagnostic and Statistical Manual of Mental Disorders published by American Psychiatric Association.  The DSM - and its European counterpart the ICD -  are used by mental health professionals to diagnose mental disorders like depression, ADHD, bipolar, borderline personality and schizophrenia.

While often thought to be ‘scientific’, the DSM is largely the product of insider turf wars, political compromise, industry needs and billing concerns.   It is said to be atheoretical, but unquestionably the DSM views certain aspects of human experience as abnormal/ disorders.  Possibly, this is just a nod to the practicalities of healthcare reimbursement.  However, the process of distinguishing the truly abnormal (insurance pays) from the common effects of a stressful life (you pay) has left something to be desired.

Rote symptom checklists determine whether your anxiety, mood, grief, trauma, substance use, sexuality is ‘normal’ or ‘disordered.’  At a minimum, this is a lousy way to get to know another human being on the worst day of their life. Painful experiences, like getting fired, ending up homeless or being raped in shelter housing are routinely ignored or overlooked. It’s like the teacher pronouncing you ‘learning disordered’ without asking if you studied.

Reliability and validity have proved problematic as well. Individual diagnoses tend to vary, as do predictions of violence and suicide.  Given that single bad call can change the course of a lifetime, concerns like these led whistleblower Paula Caplan, Ph.D., to report to the Washington Post in 2012: “Psychiatry’s bible, the DSM, is doing more harm than good.”  

Since that time, things have gotten worse for the DSM, not better.  In a stunning reversal, world-renowned psychiatrist, Allen Frances, MD – the man who spear-headed the modern DSM classification system - described DSM-5 as ‘deeply flawed and scientifically unsound.’ A former Director of the National Institute of Mental Health (think science, research, evidence-based), Dr Steven Hyman, called DSM-5 ‘totally wrong, an absolute scientific nightmare.’  In April 2013, the NIMH formally went on record as looking for a more valid approach.  According to then-director Thomas Insel, MD, ‘Patients…deserve better.’

2. The Medical Model of ‘mental illness’


In contrast to the DSM, the Medical Model has a crystal clear vision:

‘Mental illness’ is a real disease.  It is caused by pre-existing genetic, biochemical or physiologic abnormalities. Those affected are susceptible to disregarding personal welfare or that of others. Aggressive treatment (drugs, shock, CBT) is required to correct or mitigate deficiencies.

For all its theoretical congruence, the medical model hasn’t fared much better than the DSM. Treating ‘mental illness’ takes a whopping 15-25 years (on average!) off of the average life span.  The promised ‘chemical imbalances’ and bio-markers still haven’t materialized in the research.  Disability rates have sky-rocketed.  Long-term outcomes and relapse rates have worsened overall.   Many suspect that prescribed drugs increase violence and suicide.

Accordingly, in May 2013, the UK Division of Clinical Psychology called for the end of biomedical disease model of ‘mental.  In the professional opinion of these psychologists, both the SM and ICD classifications systems possess limited practical and research utility.  The disease model on which they are based is significantly flawed and a paradigm shift is desperately needed to address the impact of psychosocial factors on mental distress and human behavior.  

Resources:

Caplan, PJ (1995). They Say You’re Crazy: How The World’s Most Powerful Psychiatrists Decide Who’s Normal  (Perseus Books: www.aw.com/gb).

Caplan, PJ (April 27, 2012). Psychiatry’s bible, the DSM, is doing more harm than good, https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html?utm_term=.bf2d94b01bb8

Cassani, M (August 9, 2014)  Treatment resistant mental illness? or Iatrogenic (drug-induced) illness?, https://beyondmeds.com/2014/08/09/treatment-resistant-mental-illness-or-iatrogenic-drug-induced-illness/ (resources cited therein)

Division of Clinical Psychology Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses: Time for a Paradigm Shift, https://www.madinamerica.com/wp-content/uploads/2013/05/DCP-Position-Statement-on-Classification.pdf

Insel, T (April 29, 2013). Transforming Diagnosis, https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

Johnstone, L (May 2013) UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model, https://www.madinamerica.com/2013/05/uk-clinical-psychologists-call-for-the-abandonment-of-psychiatric-diagnosis-and-the-disease-model/?platform=hootsuite.

Scull, A, Madness and Meaning (April 22, 2015), https://www.theparisreview.org/blog/2015/04/22/madness-and-meaning/

Whitaker, RH (2010). Anatomy of an Epidemic. New York: Random House.

Wikipedia, Humorism, https://en.wikipedia.org/wiki/Humorism

Chapter 2: ‘Gutting’ Conventional Behavioral Health

(in progress)

In the past several decades, it has become common in other fields – like physics – to wonder if there might be some kind of ‘Grand Unified Theory’ (GUT) that makes sense of the entire known physical world.  For the most part, that hasn’t happened in behavioral health.  Thus, troubling social phenomena – like ‘mental illness’, ‘addictions’, bullying, discrimination, disability, abuse, neglect, poverty, violence, crime, victimization, homelessness – are still seen as largely separate issues.  At the same time, there is tremendous overlap.  The fact is, these misfortunes tend to cluster and recur in the same people.  So it’s more likely that if you have one of these issues, you’ll have a second.  And, if you already have two, you’re more likely to have a third.  Have three?  Then you’ll probably have a fourth! -   And so on…  

What’s the connection here?  Are these phenomena really distinct?  Or, like physics, is there an underlying common thread that connects them?  Equally important, if they are related, what is the relationship and what does this tell us about where to go from here?  Are there reasoned approaches we can take, not just individually, but also as neighbors, families, friends, neighbors – as communities, schools, healthcare providers  - even as businesses, investors and insurers?  Are there actual concrete, affordable, achievable things we can do to minimize problems and promote solutions in the areas of human well-being that we value the most.

This manual came about as a result of asking questions like these.  They are just a small sampling of the questions I had that conventional behavioral health doesn’t satisfyingly answer.  Some questions, like those above, were motivated by intellectual curiosity:  Things looked and felt related to me, but how...?

Other questions I had were personal and intensely, painful.  They included questions like:

  • Why do I get verbally attacking when I feel vulnerable? 
  • Why does it feel like an addiction? 
  • Why does it feel like aggression to others, but inside I actually feel beat up and traumatized? 
  • Why can’t I seem to stop doing this attacking behavior despite years of trying and all it has cost me, personally, professionally, socially?   
I sat with some of these questions for decades.  Finally, for myself at least, I think I have some answers.

Accordingly, this manual will lay out what, for me, has become a sort of Grand Unified Theory (GUT) of Psychosocial Functioning.  Maybe the answers I suggest will speak to you.  Or, maybe they inspire you to make your own inquiry.  Maybe you, not me, will take us all to the next level.
Regardless, my hope in writing this is to make a beginning.  There are still way too many problems that conventional behavioral health doesn’t come close to fixing. To the contrary, the sad fact is that far too often – and for far too many of us -- conventional approaches actually may make things worse.

Possibly, together, we can change that.  As users, survivors and allies, perhaps we can learn to sit together with our honest questions –  all the stuff we’ve been told by ‘helpers’ that doesn’t fit for us. If we can own our questions and our experiences – rather than just caving to the experts and going along to get along - then maybe, somehow, some day, we can come up with some answers that honestly do make sense to us.  It’s a great way not only to help ourselves, but also to save future generations from some of the pain and confusion we are going through as individuals – and a people – right now.

Not Broken Biology: Getting Beyond the Disease Model Paradigm of 'Mental Illness'

(in progress)

Introduction


Chapter 1: Maniacally Sane
http://peerlyhuman.blogspot.com/2017/03/chapter-1-maniacally-sane.html

Chapter 2: ‘Gutting’ Conventional Behavioral Health
http://peerlyhuman.blogspot.com/2017/03/chapter-2-gutting-conventional.html

Part I:  A Defective Theory of Mental Defects


Chapter 1: Defective Theories of Mental Defects
http://peerlyhuman.blogspot.com/2017/03/chapter-1-defective-theories-of-mental.html

Chapter 2: Social Determinants of Behavioral Health
http://peerlyhuman.blogspot.com/2017/03/chapter-2-social-determinants-of.html

Chapter 3: Medical model outcomes
http://peerlyhuman.blogspot.com/2017/03/chapter-3-medical-model-outcomes.html




Part II: Where to Go From Here


Chapter 1: Where Medicine Ends and Life Begins


Chapter 2: The Appeal and Limits of the Disease Model


Chapter 3: The Search for Non-Medical Alternatives


Chapter 4: Facing the Facts of Life


Part III: Not Broken Biology


Chapter 1: It Looks Like Bipolar and Acts Like Bipolar, But… 34
Chapter 2. Why It’s Not Bipolar 36
Chapter 3. The Human Survival Response in a Nutshell 37
Chapter 4. Gearing Up for Survival 39
Chapter 5: Two Brains, Two Bodies 41
Chapter 6: Explaining So-Called ‘Mental Illness’ 42
Chapter 7:  Explaining Particular ‘Disorders’ and Symptoms 45
Chapter 8: Why ‘The Illness’ Keeps Getting Worse 48
Chapter 9: Why ‘Mental Illness’ is a Vicious Cycle and a Catch-22 49
Chapter 10: Diagnosis?  Widespread Relational Impoverishment! 50

Part IV: Where to Go From Here


Chapter 1. Turning Off the High-Stakes System 55
Chapter 2: We Need a New ‘Recovery’ 56
Chapter 3: Common Problem, Common Solution 59
Chapter 4: Assessing High Stakes Reactivity 61
Chapter 5: Working With High Stakes Reactivity 78
Chapter 6: Changing Your Relationship to High Stakes Reactivity 85
Chapter 7: When It’s Your Own High-Stakes Reactivity 86
Chapter 8: When Someone Else is in High Stakes Reactivity 119
Chapter 8: When You’re Both in High Stakes Reactivity 129

Part V: Messages to the Behavioral Health System


Chapter 1: Rethinking Professional Roles 131
Chapter 2: Redefining ‘Ethical’ 132
Chapter 3: Why Mutual Regard Works 133
Chapter 4: Why Coercion, Force, & Confrontation Make Things Worse 134
Costing Us Our Conscience: The unbearably high price of conventional mental health 135

Part VI: Message to Lawyers, Lawmakers and Activists


Chapter 1: Moratorium on Diagnosis 139
Chapter 2: Consumer Protection 140
Chapter 3: Expert Witlesses 141
Chapter 4: Meaningful Research 142
Chapter 5: Experts by Experience 143
Chapter 6: Community Alternatives 144
Chapter 7: Minimum Standards for Community Health 145

Part VII. Message to the Caring Public


Chapter 1:Why Psychiatric Labels Are More Deadly Than Guns 155
Chapter 2: Have You Noticed the Two Americas in Mental Health? 164
Chapter 3: The REAL Threat to Public Safety is Marginalization 167
Chapter 4: Bury My Heart At Wounded Psyche 175
Chapter 5: "I Am Proud to Be Maladjusted" - Dr. Martin Luther King, Jr. 180
Chapter 6: Iatrogenic Advocates - Modern Guardians of "The Mentally Ill" 148
Chapter 7: Lived Experience Must Get A Fair Hearing 153

Appendix: 12 Steps for Everyone


Introduction: What is Peerly Human?
Chapter 1: Reality is the Problem 90
Chapter 2: Reality Suggests Some Possible Solutions 92
Chapter 3: Ready to Try Differently…? 99
Chapter 4: Who Am I, Really…? 100
Chapter 5: Finding People Who Make it Better Instead of Worse 111
Chapter 6: Sifting and Winnowing 112
Chapter 7: Getting to the Heart and Soul of the Matter 113
Chapter 8: Uncovering Our Tracks 114
Chapter 9: Recognition and Reconciliation 115
Chapter 10: Maintaining Integrity 116
Chapter 11: Rinse, Repeat 117
Chapter 12: Living Into the ‘Soul Force’ 118


Chapter 1: Maniacally Sane

(in progress)
I
t is a bit unnerving to write this. What follows basically proposes a new paradigm for psychosocial well-being.  It takes current understandings of behavioral health, and turns them on their head.  It suggests that there is a simple, straight-forward, elegant way of making sense of major social issues like ‘mental illness’, ‘addiction’, ‘violence’, and ‘crime.’   It also points to clear, understandable, practical strategies for addressing these issues on individual, social and cultural levels.

As a person who has been labelled mentally ill – as well as someone who has worked in the field – I am well-aware of the implications.  Any non-expert who makes such claims in modern times will at the very least be labeled ‘grandiose.’  On short order, a lot of us can expect to be on a back ward some where getting shot up with the latest rendition of bipolar meds.

At the same time, the results for me of this shift in perspective have been revolutionary.  I have had 8 official diagnoses and about that many ‘rule outs.’  I have tried over 20 meds, and countless alternative treatments.  However, it wasn’t until I put a few simple facts together about myself, human physiology and normal psychosocial functioning, that I was able to make sense of what was happening for me and to effectively do something about it.  What I have works for me. I suspect it can work for at least some others, possibly a lot of others.

In sum, this is the manual I would have wanted for me, if I had known what I know now at age 16 when I first entered the mental health system. It explains what I’m up against and what I have to work with.  It is straight forward, plain language and practical. I can – and do – use it on a day to day basis to make sense of my experience and decide how to respond.  Better yet, it doesn’t require me to think of myself – or my reactions – as ill, disordered or inappropriate.  To the contrary, it helps me to find the hidden strength, value, and wisdom in personal idiosyncracies that conventional approaches tend to marginalize.

If this manual helps you reflect on your own experience – and perhaps develop something that works even better for you – then it has served an important purpose.  Hopefully it will do other things as well:


  1. Help family members understand and effectively relate to each other across very different viewpoints and realities
  2. Help clinicians appreciate the value of the people and experiences they are currently labeling ‘mentally ill’, ‘disordered’, ‘antisocial’ or ‘psychotic.’
  3. Help professional organizations advocate for the internal and systemic changes required to effectively assist the vulnerable citizens they claim to serve.
  4. Help politicians credibly articulate the changes in policy and resource allocation that are needed to meaningfully create and maintain public health that will benefit those at all levels of society
  5. Help the general public understand why such changes are needed, how they can be achieved and the concrete benefits they can expect from their efforts.


Obviously, that’s a tall order.  So let’s get started.