One of the biggest clown doctors going at the present moment has got to be Ronald Pies. It would be remiss of me to claim that in his latest post, Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, he has outdone himself. If there was anyone destined for a pie in the face that anyone has got to be Ronald Pies. I would be honored, in fact, to bestow upon Dr. Pies the moniker Ronald “Pie In The Face” Pies for all posterity. Ronald Pies is a marvel of nonsensical shrink think. In his latest escapade into the theory and practice of shrinkery, Pies, by some disingenuous twist of convoluted illogic, would blame “the chemical imbalance theory” on that bug-a-boo and will-o-the-wisp of modern psychiatry, antipsychiatry. Go figure.
Now, if you were to give credence to a recent online polemic posing as investigative journalism, you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called “Psychiatry” has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).
Those first two statements Pies alludes to here would be those that indicate either “mental illnesses” were caused by “chemical imbalances” in the brain, or merely that more “serious mental illnesses” were caused by “chemical imbalances” in the brain. What we don’t get out of this story is precisely who was responsible for promoting and spreading this “chemical imbalance theory” that these people in some antipsychiatry movement would be exposing. Where is psychiatry here? Defending itself from those who would be exposing a discredited theory. Certainly it is not defending itself from the ones who would be promulgating that theory. Curious indeed.
Among his more bizarre notions is the notion that this “chemical imbalance” theory has more to do with some catecholamine hypothesis from many years back than it does with the development, marketing and advertising of those trendy psychiatric drugs still surging strong on the market of today.
To the extent the “chemical imbalance” notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the “chemical imbalance theory” was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.
Does Dr. Pies mean that psychiatrists don’t use, or shouldn’t use, those drugs that would be advertised as purporting to correct some kind of postulated and theoretical “chemical imbalance”? I think not. This leads to another question. To what extent has psychiatry, or the majority of its practitioners, colluded with pharmaceutical companies in producing an atmosphere that now has commercial interests in the media peddling pills, not just to medical professionals, but to the entire buying public perceived and re-envisioned as consumers who will purchase anything at the provocation of the most mesmerizing sound bite?
Psychiatry’s critics also conveniently omit reference to what was arguably the most prevalent paradigm in academic psychiatry, during the 1980s and beyond: the biopsychosocial model (BPSM) of Dr. George Engel. The BPSM has been subjected to much criticism, and some would argue that few psychiatrists nowadays use the BPSM in a systematic, evidence-based manner. And in recent years, several prominent psychiatrists have warned that “…pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.”
In the latex gloved mitts of Dr. Pies, our babble here has degenerated into very nuanced babble indeed. If you will notice, despite the nip at bio babble unrefined, bio still has top billing in the theoretical credits. I don’t think this is entirely because of the order of words in the alphabet, or accidental. The mad doctor has shown himself sufficiently proficient in blurring the lines between disciplines to earn himself a rank of major distinction in the therapeutic circus. If criticism equals antipsychiatry, well, there you go. The message is coming in loud and clear. Don’t criticize psychiatry or you must be promoting the discredited “chemical imbalance theory”, too. Clown psychiatry rules!
Filed under: antipsychiatry, Biological Psychiatry, Commerse, Conflict of Interest, Direct To Consumer Advertising, Disinformation, Education, Fun, Media, Mental Health Care, Pharmaceutical Company, Psychiatric Drugs | Tagged: chemical imbalance theory, Ronald Pies | Leave a comment »
One Deinstitutionalization Is Not Two Deinstitutionalizations
Much bad ink has been spilled over calling the nation’s jails and prisons mental health facilities because of the number of people within their walls who have also been given psychiatric labels. The latest report along these lines claims there are something like 10xs more mental patients who reside in criminal justice facilities than in state hospitals. These numbers come from a study conducted by the Treatment Advocacy Center, the USA’s number one lobbyist for more forced psychiatric drugging, and the National Sheriffs Association. The culprit in this debacle is said to be deinstitutionalization.
Let me start off by saying people don’t go to jails and prisons because they are sick and because they wish to receive medical attention. People are sent to jails and prisons by the courts to receive punishments because they broke the law of the land. Second, state hospitals have traditionally been psychiatric jails and prisons. Merely trading this kind of prison for the other kind of prison doesn’t make a hospital in actual fact. I would say that, given the prison overcrowding problem that comes of three strikes laws, America has grown increasingly intolerant of difference, and law crazy itself. If your way of dealing with bizarre behavior is to outlaw it, your jails and prisons are going to fill with people behaving bizarrely. Bizarre behavior may be a crime, but it is only a disease by a wild stretch of the overactive imagination.
Statistics tell us their own story. For statistics, before we look at those coming from the recent study, let me refer to the Preface of the 2006 book crazy authored by journalist Pete Earley. Earley is another apostle of this blame deinstitutionalization religion. According to Earley, in 1955, there were 560,000 people in state mental hospitals. He speculates not about the numbers of people who might have been referred to as “mentally ill” in prison or jail at that time. Between 1955 and the year 2000, the population jumped from 166 million people to 276 million people. Given this population increase, and no change, the numbers of people in state mental hospitals would have been something like 930,000. Earley gives the present number of people, from maybe a 2002 or thereabouts survey, with “mental illnesses” in jails and prisons at 300,000. He gives the present number in state mental hospitals at 55,000.
Hmmm. Something peculiar is going on here. 500,000 people are unaccounted for. These are the people who, with the population increase figured in, would be in the state mental hospital system if we were still doing business the way we had in 1955. 500,000 people is more than half the number of people we are dealing with in the stats for a later year. You add 55,000 to 300,000 and you are still lacking 205,000 people from the 1955 figure. This is not the kind of figure that supports the contention that deinstitutionalization was a mistake, or that it was a disastrous failure. Instead it would seem to indicate that more and more people described as “mentally ill”, if not fully recovering, are being better integrated into the communities from which they came. This is a coup for least restrictive care, and least restrictive care is something that nobody receives as a prisoner on the locked ward of a state mental hospital.
According to the TAC and NSA research, there are 35,000 people in state hospitals, a 2012 stat, and 356,000 in jails and prison. Wow. We’ve got 20,000 fewer people, referencing the Earley stats, in state mental hospitals than we had 10 or so years earlier! If we’ve got more in jails and prison, too, part of that increase can be explained by population increase. What Earley gave us was something of an estimation based on statistics anyway, but we’re still minus a great number of people who would be “hospitalized” in the year 1955. All in all, I’d call deinstitutionalization a major success story. We’ve still got a lot of people in jails and prisons, given stiffer sentences and overcrowding, who don’t need to be there. One deinstitutionalization success story doesn’t justify an increased amount of institutionalization for another sort of institution.
Blaming violence on “mental illness” is the latest media and political trend. I’d like to remind people that the court of public opinion is not a court of law. We have a supply of the kind of acts, in the present climate, that the media circus demands. Should we look at the number of violent acts committed by people with no experience in the mental health treatment system, I’m sure that those crimes are not decreasing dramatically in number either. Violence is not a symptom of any “mental disorder” in the Diagnostic and Statistical Manual (DSM). When it comes down to it, death is much more likely to be a result of gun fire than it is to be a result of any psychiatric diagnostic label in a mental health professional’s repertoire. I suggest that we will have more success with the problem if we deal with the causes, and I don’t see “illness”, physical nor mental, as one of the primary causes. I would, on the other hand, do something about the climate of suspicion, hatred, and indifference that breeds crime, hardship, and troubles. Here, I think we can actually make a difference if we tried, and that is exactly what we should do.
Filed under: Alternatives, Biological Psychiatry, Criminalization, Discrimination, DSM, Force, Human Rights, Insanity Defence, Law, Mental Health Care, Misdiagnosis, Oppression, Politics, Recovery, Research, State Hospital, Violence | 3 Comments »
Social control is becoming very scary business these days. The supreme court of the USA just decided putting a limit on political campaign contributions is unconstitutional. This is the same USA that has a majority of millionaire elected officials serving in congress. Millionaires are, on the other hand, a very small minority of the overall population. Billionaires, too, but now billionaires have renewed opportunities to buy political influence from millionaires. As they say, follow the money. Following the money is apparently the only way you’re going to find out what’s really going on here. If 1 % of the population owns 80 % of the nations wealth, a great deal of the population is going to be under represented in the political process.
These elected millionaires often got to be millionaires through their associations, specifically their associations with politics and politicians. Not only is influence peddling big business, but big business is influence peddling. All sorts of lobbyists are making cracker jack deals with politicians. Should the lobbyists be lobbying to advance the interests of poor people, well, there’s no money in that, is there? Social justice takes a backseat to profiteering. Representatives, who get paid by the state, also tend to be lawyers with their own law practices. These law practices are more likely to serve people with money than they are to serve people without money. The law business must run on something, too, after all. Much of the business of law is about protecting the money of people who have money.
Living In a country where more and more people own less and less can be very frustrating. Sometimes this frustration shows up in the crime rate. Sometimes this frustration explodes into an excessive overt expression of gratuitous violence. It is convenient, in a such a case, especially for the profiteers, to come up with a scapegoat to blame this gratuitous violence on. By doing so, the manufacturers of social discontent themselves are left off the hook as far as accountability is concerned. One way they have managed to do this in recent history is by scapegoating the customary scapegoat. The customary scapegoat is, was, and remains, anybody with the misfortune of being swept up into the mental health system dragnet as a mental patient, or “consumer”.
“Mental illness” itself is a pretty sketchy concept. There are no reliable tests for it. Troubles, a universal phenomenon, of any sort, are enough to elicit a labeling response from the thin skinned mental health profession. Frustration, as you may well suppose, can be listed among troubles. Essentially, a person with a “mental illness” is a person who has been made into a scapegoat. “Stigma” itself started as a brand or a tattoo used to mark slaves as property or to identify criminals as wrong doers. Although that mark is gone, the paper trail that goes along with commitment hearings and inpatient treatment, brands any individual who has been through the mental health system a perpetual outsider as surely as a glowing iron set among hot coals. All that person has to do to run into a snag is to fill out any form that screens for mental health by asking about psychiatric treatment history.
Psychiatry’s answer is to claim that scapegoats are scapegoats because they have scapegoat genes. This circumspect approach, of course, misses entirely the social connections that contribute to any determination of success or failure. Take a classroom situation, for instance. A student turns in a paper that elicits some sort of objection from a teacher. The teacher gives the student a poor grade. Another student gets a good grade. All sort of social considerations, many of them unstated, go into who shall get the passing grade and who shall get the failing grade. Sometimes the determining factor can be something as slight as the color of a person’s skin. Of course, skin color is in the genes. Academic performance, on the other hand, should be in the knowledge, and in the acquired knowledge at that.
There are those who like to call the mental health system “broken”. There are usually two reasons for doing so. One is that a person would like to see more money pumped into the mental health system. The other is that they are encountering people they don’t want to encounter, and they feel that if the system worked, the sight of these people would not be disturbing them so.
I don’t call the mental health system “broken”. The mental health system is actually a “mental illness” system and, if anything, it “works” altogether too well. We’ve got a saying, “Children should be seen and not heard.” This saying leads up to a further, but unexpressed, saying, “Adult children should neither be seen nor heard.” What do we do with our adult children? There’s the loony bin. You figure it out.
If “mental illness”, as the late Thomas Szasz claimed, is a metaphor. “Mental health” is a metaphor as well. Bodies get physical diseases. Minds just get fuzzy, half-baked ideas, and illogical thoughts. The pursuit of folly though is not a disease any more than the pursuit of wisdom is a cure. We are free to chose either pursuit, or neither, as we wish. Of course, despite the fact that no disease has been found to explain aberrant behaviors, that doesn’t prevent people from speculating about “disease” as a cause.
If you’re going to call the mental health system “broken”, the first question one has to ask is what is the purpose of the mental health system. For example, is the mental health system there to “heal sick” people, to “fix broken brains”? If so, it has always done an absolutely lousy job not “healing” and not “fixing” them. I submit that the real purpose of the mental health system is to keep people with psychiatric labels out of other people’s hair. This, the system, considering the shots it has taken due to scandals arising from institutionalization, does sufficiently enough.
What is a mental hospital? Is it a place for “healing sick” people, or is it a place for punishing people who behave “badly”? While the nurses station found on most psych wards suggests the former, the locked doors found in nearly all of them says it is the latter. All you have to do is to consult the dictionary to get the idea that something is awry here. A mental hospital is a peculiar hospital, to say the least, but it is a particular prison. The distinction between the two depends upon whether you think it does a better job “healing the sick”, or punishing the misbehaving.
I echo Dr. Szasz in calling for the abolition of forced mental health treatment. The system, as meat grinder, as a destroyer of men and women, isn’t broken in the slightest. It does it’s job of breaking spirits, of swallowing up bodies, and of spitting out bones exquisitely well. I think, if they really and truly cared about their clients, more mental health professionals would be taking the same position. This destroying of people, by going straight at their potentials, and watching them fizzle, is a thing that should not be tolerated. Difference should be expected and encouraged, not suppressed.
This accent on perceiving a “broken” system is a call for reform, and this reform usually means one of two things. Either people think it is too hard to get people treatment, or people think the treatment they receive too harsh. I am against reform as reform is always piece-meal, and there’s no end to it. Reform always, and of necessity, leads to further reform. I support the abolition of forced mental health treatment. Prejudice and discrimination, so-called “stigma”, comes of force. End forced mental health treatment, and you will also be ending so many things that are wrong with the mental health system today. There is no reason, no good reason anyway, in my opinion, for persevering in the present farce of pretending otherwise.
Filed under: Alternatives, Biological Psychiatry, Discrimination, Force, Human Rights, Mental Health Care, Mental Health Screening, Misdiagnosis, Oppression, Outpatient Commitment, Violence | Tagged: mental health system | 22 Comments »
There are few people more in need of mental health treatment today than mental health professionals, unless perhaps we think about treating the relatives of people with “mental illness” labels. Yes, the very people who lock people up should be locked up on account of their proclivity to lock people up. We should give it a “disease” label and treatment. Fair is only fair as foul is awfully foul. It’s just plain un-American.
My reason for going there? I’m seeing all these well intentioned people interested in doing something about “mental health issues”, and that something amounts to, in effect, throwing a flammable liquid on the fire in an effort to put it out. We have an epidemic of “mental illness” labeling in this country, and the method we’ve come up with for dealing with it is by doing everything within our powers to increase the amount of labeling going on.
Our schools, deathly afraid of producing psycho-killers, are training teachers to screen their classes for any indication of “mental illness”. Isolating and treating the labeled student is supposed to be a violence prevention measure. If the kid is just a little weird and not violent in the slightest. It doesn’t matter. The weird student must bear a psychiatric label, and be scrutinized for his or her potential to do harm, however speculative.
It was rumored when I was a kid that we’d driven a teacher to distraction, or insane, for lack of a better term. No more. Now schools have got the conduct problem licked as conduct is no longer a grade on a report card. Bad conduct, misbehaving, is now, according to our pediatric psychiatrists, a bona fide “mental health disorder”. Given this circumstance, class clown is no longer bound for the circus, but rather for the loony bin. That’s right, clowning is a certifiable “disease”.
I had this friend with the “borderline” label who was going on to me about how important it is to take “mental disorders” seriously. I fell automatically into disagreement with this person. I think taking “mental disorder” seriously is the most direct way to developing a more “serious mental disorder” that I can imagine. Maintaining a sense of humor is the best medicine for this sort of thing. Whatever sort of “disorder” you might have developed, as long as you take it lightly, it can’t be serious.
Of course, if you don’t take your “mental disorder” seriously you are in danger of being nabbed for conduct disorder. Everybody has a “mental disorder”, even if the “mental disorder” a person has hasn’t been invented yet. Some of us just haven’t been caught. Were your “mental disorder” actually an order, that wouldn’t be so bad, unless, of course, it involved orders from the planet Xylon. Disorders from Xylon, that’s okay.
My point? Well, judging from the news, everyday of the week, we are locking up the wrong people. The people least responsible for greenhouse warming, mass extinction, corporate imperialism, poverty and international conflict are often the people who we have selected to endure our psychiatric institutions as patient-prisoners. I’d like to point out that this is more an instance of ruining the world rather than it is of saving it. Have we made a mistake? Yes, I think so, and many mistakes at that.
Filed under: Biological Psychiatry, Children and Adolescents, Discrimination, Disinformation, DSM, Ethics, Force, Human Rights, Mental Health Screening, Misdiagnosis, Oppression, Violence | Tagged: mental disorders, mental health issues, mental illness | 6 Comments »
I’m not part of the mental health movement. I don’t beg for money from the state. I don’t think the state should subsidize “mental illness”. This is an awkward position to take because I am also a psychiatric survivor, and the psychiatric survivor movement has, in a sense, become absorbed into the broader c/s/x or consumer survivor ex-patient movement.
Let me explain. Many people who call themselves psychiatric survivors are part of the mental health movement. When our movement began we were a separatist movement, that is, knowing how badly the state treated people in the psychiatric institutions it ran, we were intent on creating our own separate places where we could truly care for people who were suffering, for people who were being abused by the state. There was, in this, a call for what became known as drop-in centers.
Fast forward 20 or 30 years. These drop-in centers have evolved, in some cases, into peer support centers. What has taken place couldn’t take place without collusion or collaboration with the government at one level or another. This collaboration has essentially turned a great many former mental patients into mental health paraprofessionals. It has also made many of these places that were once alternatives to force and abuse alternatives in name only.
Many of us got into the movement, not because we wanted treatment, but because we didn’t want treatment. We received treatment regardless. It was thrust upon us against our will and wishes. We felt compelled by this force to do two things; one was look to creating the alternatives I just alluded to, and the other was to support the abolition of all forced and harmful mental health treatment.
The question then becomes, when a former mental patient becomes a mental health worker, must he or she of necessity resort to the same wrongs he or she was initially protesting. In other words, does this position have a tendency to turn psychiatric survivor former patients into turncoats, and oppressive turncoats at that, even if this oppression is now more subtle and cleverly disguised.
Psychiatrists may be the most powerful people in the mental health profession, but corruption in the mental health field is by no means restricted to psychiatrists. The mental health system is growing, it is not stabilizing, nor is it contracting. Either “mental illness” is contagious, doctors are better at detecting it, or personal failure as a business, as other people’s success, is thriving.
Federal and state money, tax payer money, has made the mental health system even harder to escape from than it was in years past. Calling the mental patient by another name doesn’t change the mental patient role. Part of the problem is economic damage and financial dependency, and there are forces at work now that are more intent on maintaining the problem than they are at ever coming up with any solutions.
The mental health community is somehow separate from the community at large, even if it is contained within it. When we talk about the mental health community, we are mainly talking about the community that has evolved around the business of outpatient treatment, or so called community care. Perhaps a better way to refer to outpatient treatment would be to refer to it as limbo. Perhaps not.
Outpatient treatment aside, my guess is that a mental patient who was integrated into the community he or she came from would no longer be a mental patient. This seamless integration business seems to have hit a few major snags of late. This doesn’t mean that getting people back into the non-mental health community isn’t something we should be striving for. There, I think we have something we can work on together now.