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We Regret to Belatedly Announce the Death of Psychologist/ex psychiatrized survivour and
Successful Schizophrenia
website owner,
Al Siebert, PhD
1934 - 2009
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The American Psychiatric Association has stayed closed for years about
creating a fifth version of their "label bible." Because of internal
disagreements, the APA postponed their publishing date of the
"Diagnostic and Statistical Manual - Fifth Edition" or DSM-5, to May
2013.
In response to claims that their process lacked transparency, the APA
has had a web site up for public comments about the draft DSM 5.
But infighting continues. The chair of the previous edition denounced
the online draft of DSM 5 as "wholesale medical imperialism, " in the
LA Times! See:
http://bit.ly/ dsm-5-frances
And now you only have days to get in on their fun!
ACTION: Lodge a civil, public objection to the APA on their very own
web site about the unscientific, undemocratic DSM. Call for
Congressional hearings about harm caused by psychiatric labeling.
It takes just a moment to register and comment, here:
http://www.dsm5. org
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Alles Wissenswerte über Psychiatrie
True facts about psychiatry [January 25, 2010]
Inhaltsverzeichnis [Sprache entspricht den Titeln]
In German and English
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SHELLEY JENSEN
Port Coquitlam, B.C. Shelley Jensen is the founder of Shelley's Angels Society and "S" Team Counselling Services. She is a Professional Counsellor and Nutritional Consultant.
Over the past 18 years Shelley has dedicated her life to researching, learning and loving the compulsive eater. Childhood obesity sparked the beginning of a struggle with episodes of bulimia, and binge eating disorder that went well into her 20's.
After seeking therapy, she has experienced the joy of recovery for over 20 years and founded Shelley's Angels Society a non-profit organization providing bursaries for those unable to afford private counselling and treatment.
After working in the weight loss industry for many years, she watched as it added fuel to the fire of Eating Disorders and dreamed of a time when she could share her passion to empower women to reconnect with their bodies and their innate wisdom.
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The Following Section is from the blog of:
Christopher Lane, Ph.D.
Christopher Lane is the Pearce Miller Research Professor at Northwestern University. He teaches and writes about Victorian and modern literature and intellectual history, including psychology and psychiatry. His books include The Burdens of Intimacy, Hatred and Civility, and Shyness: How Normal Behavior Became a Sickness. He's written for the New York Times, Washington Post, Los Angeles Times, Boston Globe, New York Sun, Herald Tribune, and New Statesman and Society.
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The More Things Change . . . The Uphill Struggle to Revise and Reform the DSM
- Mon, 12 Jul 2010 20:08:24 +0000
Three days ago, Dr. Nassir Ghaemi posted a thought-provoking piece on the power of psychiatric terminology, including the problems that stem from widespread misuse of the term "disorder" ("The Disorder of 'Disorder'"). Though his post has already received several replies, I didn't want the conversation to end or the issue to disappear.
I disagree with many of Nassir Ghaemi's underlying assumptions about psychiatric diagnosis, as well as his conclusion that the "best way" forward is to "jettison . . . the term 'disorder' and replace it with 'disease' when biological disease is present," but I have to applaud his willingness to speak openly about the many blind spots that still trouble psychiatric thinking, including over the meaning and centrality of the term "disorder."
Dr. Ghaemi argues that the term was adopted for the third edition of the DSM because it was "suitably vague and eclectic enough to serve" several purposes. That sounds right to me, and it corroborates my research on the DSM-III papers at the APA in Arlington, VA. In sounding biological, the task force shunted aside competing diagnostic systems, including psychoanalytic, existential, and environmental ones. It tried but failed to solve the mind-brain duality that has haunted American psychiatry since at least the nineteenth century. It also gave American psychiatry a patina of credibility by sounding scientific and evidence-based, even when both the science and the evidence were sorely lacking. As Ted Millon, a consultant to the DSM-III task force, openly admitted to the New Yorker magazine in January 2005, "There was very little systematic research [in what we did], and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest."
Dr. Ghaemi calls the DSM-III claim that it was "agnostic" over etiology, or the cause of mental distress, "in retrospect an exercise in self-deception," and I would have to agree with him there too, though I don't think the participants were the only ones who ended up somewhat deceived or in the dark. What about the public? Alas, the exercise in self-deception is still continuing, with many strongly defending it, even though others wisely have written, concerning DSM-5, "Let's call the whole thing off." I wish we could.
Maybe with senior figures as important to the revision process as Dr. Ghaemi acknowledging that it's time for academic psychiatrists to speak openly and willingly about what they do and do not know about psychiatric distress, reactions, conditions, and diseases, calling the whole thing off in terms of updating the DSM may be the only viable outcome for psychiatry. That would seem almost obvious given the high stakes for public health over any mistakes, errors of judgment, or errors of fact. Dr. Ghaemi writes,"We need to have the courage of our science, both in expressing what we know, but, more importantly, in proudly announcing and avowing our ignorance, while we continue to engage in that scientific work."
Many of us wouldn't find that proud avowal of ignorance especially reassuring--not when the APA insists, as its brass told the U.S. Food and Drug Administration's Psychopharmacologic Drugs Advisory Committee in January 2005, "Mental disorders affect--and often severely disable--some 48 million Americans across the lifespan."
"Some 48 million." Determining the accuracy of that statement depends critically on how one defines the rest of the sentence, starting with "some," "mental disorders," "affect," "across the lifespan," and even "Americans," since I'm guessing the APA didn't mean to include South and Central America, plus Canada. Those 48 million people have one thing in common: they apparently are affected by the same set of "disorders," the very noun that's at the heart of the dispute.
Given the diagnostic and interpretive doubts that tug at this process, I'm not so sure the science will come to an immediate rescue. As of course you've noticed, academic departments and the drug companies have a vested interest in keeping the status quo, especially as grant applications and so much pharmaceutical research clearly is profoundly affected by the role that DSM "disorders" play in anchoring those departments and their sources of funding.
So, unlike Dr. Ghaemi, I'm far less confident that the 36,000 physician members that comprise the APA would agree on what of the 297 "disorders" listed in the latest DSM could conceivably go, enabling the "surgical process of excision . . . to begin." It's a nice thought that it could. I sure keep a running list on the ones I'd happily strike through. But I'm not so sure the patients who've been diagnosed with those disorders, often taking powerful psychotropic drugs supposedly because of them, would feel quite so good about the logical conclusion that they had been, well, misdiagnosed and given drugs with untold side effects that they may not have needed.
Nor am I reassured that Dr. Ghaemi's own preferred terms for inclusion, which would take us back to the age of Galen, Aurelianus, Soranus, and other representatives of Greco-Roman medicine, should just be supplemented by "about 50 other such common non-disease clinical conditions." For starters, which fifty? Respondents are already weighing in on his blog, saying which ones they'd advocate to keep. Imagine that process taking place at a national level, the level of the APA. With each contributor arguing for his own corner, one can at least grasp how the diagnostic manual kept expanding at such an astonishing rate in the past, adding no less than 756 pages to a book that has sold more than a half-million copies around the world. So which dozens or even hundreds of those additional pages should go? It's a question one has to ask--and I'm frankly relieved that Dr. Ghaemi is prepared to do so--but, even so, it's clearly quite a controversial task, with potential hazards, especially if the history of the DSM is anything to go by.
The following cartoon sums up part of its Hydra-like effect:
To find out more about the history of the DSM, visit: www.christopherlane.org | Mind over Meds
- Tue, 27 Apr 2010 13:06:49 +0000
Two days ago, the magazine section of the New York Times featured a powerful article by fellow PT blogger Daniel Carlat called "Mind over Meds." The article went straight to the top of the Times' most-emailed list, where it remained until this morning—a considerable accomplishment, suggesting that it has resonated strongly with many thousands of doctors and patients, including, doubtless, readers of Psychology Today.
I commend Dr. Carlat for urging his colleagues in psychiatry to expand their treatment options to include psychodynamic psychotherapy—a robust, long-standing, and highly effective method of treating dozens of conditions that too often are viewed as treatable only by drugs. As Carlat observes, a generation of psychiatrists trained in the age of Prozac and on the promise of evidence-based medicine has grown "skeptical" of psychotherapy and often dismissed it, condescendingly, as but an empty legacy from the past, without scientific bona fides or empirical support.
One result of that prejudice, Carlat argues disturbingly, is that numerous psychiatrists have little actual curiosity about how their patients tick, and are not especially adept at listening to their concerns. Instead, the "information" these patients supply is channeled into the pre-existing grooves of a DSM diagnosis, with the psychiatrist moving to rule out diagnostic options in his or her sometimes-rapid attempt to narrow the problem to one particular disorder. "A psychiatric interview has a certain rhythm to it," Carlat observes. "You start by listening to what your patient says for a few minutes, without interrupting, all the while sorting through possible diagnoses. This vast landscape of distress has been mapped into a series of categories in psychiatry's diagnostic manual, DSM-IV. The book breaks down mental suffering into 16 groups of disorders, like mood disorders, anxiety disorders, psychotic disorders, eating disorders and several others."
Yet though I knew Carlat's article would eventually move to discussing the benefits of including some talk therapy in a psychiatrist's arsenal, as I read his account of how he used to conduct these psychiatric interviews I felt more troubled than reassured—no doubt because so many of his colleagues still operate just as he used to do.
"Toward the end of the hour," he writes about one patient dubbed J.J., "I felt confident that I had arrived at [his] diagnosis. "I think you have what we call ‘generalized anxiety disorder,'" I told him. It may start with a defined series of causes, as was true for J.J., but then it spirals outward, blanketing the world with potential threat. J.J. worried about what the future would bring and experienced a predictable series of physical symptoms: insomnia, muscle tension, irritability and poor concentration."
"'I'm going to write you a prescription for a medication called Zoloft," Carlat continues, "picking up my prescription pad. He [the patient] asked what was causing his anxiety, and I began one of the stock neurochemical explanations that psychiatrists typically offer patients about low serotonin levels in the brain. The treatment involved 'filling up the tank' by prescribing a medication like Zoloft, Celexa or Paxil."
Carlat never returns these psychiatric platitudes, which in the case of "low serotonin" has been dismissed so many times as a viable answer by so many experts that one wonders, with incredulity, how it could still circulate without irony in 2010. Of course, the patient's question about what is causing his anxiety sends Carlat onto a discussion of the mind, which alas he views as identical with the brain. Yet even in this self-reflective article on the deficiencies of his own psychiatric practice, there's no discussion of how Carlat picks one SSRI over another, whether the numerous side effects of psychotropic drugs outweigh their marginal benefit over placebo, and whether the diagnostic categories on which he still relies are quite as reliable as he seems to think they are.
When I was researching my book on the history of DSM-III and -IV, I asked Robert Spitzer, editor of the first of these editions, how he and his colleagues on the anxiety disorders subcommittee came to devise generalized anxiety disorder as a stand-alone illness. Renowned anxiety specialists such as Isaac Marks in London had warned strongly against the move, insisting that studies did not support it, and David Healy, in his book The Antidepressant Era, had called the process analogous to pulling things "out of the classificatory hat" (p. 236). With justification, it transpired.
"We came up with that name [GAD] after we had anxiety neurosis in DSM-II," Spitzer told me in February 2006, "and if you had panic then there had to be something that was left over. So that became Generalized Anxiety Disorder."
In short, the diagnosis that Dr. Carlat adopted for his patient J.J. was, for the architect of DSM-III, the "something that was left over" from panic. It didn't exactly sound evidence-based to me—and it still doesn't today.
At the end of his article, Carlat continues to insist that "mental illness is a brain disease," so reproducing the very thinking that helped to de-emphasize psychiatric attention to the mind in the first place. But he does usefully debunk the myth that psychotherapy is easier to learn and practice than biological psychiatry. "Psychopharmacology," he writes, "was infinitely easier to master than therapy, because it involved a teachable, systematic method. First, we memorized the DSM criteria for the major disorders, then we learned how to ask the patient the right questions, then we pieced together a diagnosis and finally we matched a medication with the symptoms."
While Carlat's efforts at incorporating "nonbiological" treatments into his practice are both notable and laudable, a recent article in American Psychologist on "The Efficacy of Psychodynamic Psychotherapy" powerfully underscores, with several large meta-analyses, that psychotherapy is routinely mischaracterized by psychopharmacologists and cognitive behavioral therapists as weak in getting results. Yet on the contrary, author and noted researcher Jonathan Shedler makes clear, in strict empirical terms psychotherapy is just as effective as "other therapies that have been actively promoted as ‘empirically supported' and ‘evidence based.'" "Empirical evidence supports the efficacy of psychodynamic therapy," he declares, based on meticulous meta-analyses involving thousands of patients. "The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings."
The notion that psychotherapy is less effective than drug-related treatments and cognitive behavioral therapy "appears to have taken on a life of its own," Shedler concludes, no doubt owing to drug company advertising and the prejudice of so many leading psychiatrists, but it is not based on fact. One can only hope that Shedler's and Carlat's willingness to correct that misperception and speak out about the provable clinical benefits of psychotherapy will convince psychiatrists incurious about the mental lives of their patients that they need to rethink their approach, expand their treatment options, and listen to their patients in a radically new way.
www.christopherlane.org | Have the American Media "Demonized" the CEO of BP?
- Wed, 28 Jul 2010 00:05:14 +0000
Former CEO of British Petroleum, Tony Hayward, is in more hot water today after claiming that he's been "demonized" by American coverage of the BP oil spill in the Gulf of Mexico. Mr. Hayward, who vacates his position with a guaranteed annual pension of £600,000 (roughly $900,000), and who was photographed onboard a company yacht shortly after returning to England, is reported by the BBC today as saying, "I became the public face [of the disaster] and was demonised and vilified. Whether it is fair or unfair is not the point."
But the fairness of the account is very much the point, I think. Especially as "the public face" of the disaster is a CEO aboard a company yacht when his corporation is responsible for—and at the time was unable to contain—the worst ecological catastrophe in U.S. history.
Mr. Hayward is probably best known Stateside for complaining, just a few days after arriving at the oil spill, that he wanted his life back. Clueless as to how poorly such a statement would read to a nation heartsick that an environmental catastrophe was unfolding and unraveling by the hour, BP then told the many thousands of people affected by the disaster that they were, in the eyes of BP honchos, "small people." Oil was spilling into both the Gulf and "the nation's psyche," Peter Goodman observed in the New York Times. Yet with BP's message, it was as if we'd tumbled into a Swift novel and were suddenly navigating Gulliver's Travels. It all felt weirdly eighteenth century. The British corporation came across as astonishingly feckless and tone-deaf, incompetent and uncaring.
"As oil burst from a hole in the seabed into our homes and offices via television screens," Goodman continued, "here was palpable evidence of that disarray and—worse—the fecklessness of the countermeasures deployed to contain it." “It was almost a kind of bleeding that you couldn’t stop,” noted Robert A. Bjork, a psychologist at UCLA, in Goodman's article. "You had this oozing out of this valuable stuff and people’s livelihoods getting harmed, and it was 'try this,' and 'try that,' and for weeks "nothing seemed to stop the flow."
With his very generous annual compensation, Mr. Hayward will surely have something like his life back very soon, if his days on yachts haven't already resumed. Meanwhile, the many "small people" in the Gulf whose livelihoods have been completely destroyed by the Deepwater Horizon spill will surely wonder, in amazement, how he couldn't imagine that his many blunders weren't at least partly responsible for American anger at BP.
BP once had a strong image in the States, doubtless helped by its slick multimillion dollar promotional campaigns, but it's taken Mr. Hayward just a few spectacularly inappropriate and idiotic comments to tarnish that corporate image far more than was inevitable, with his and his colleagues' colossal gaffes. Imagine: "Small people"? Given the circumstances, it would be hard to find a more patronizing and offensive phrase. And if you care about your message, BP, don't make a nonnative speaker responsible for a critical press conference.
In his stepping aside from his position as CEO, given the economic stakes for Britain and the social-environmental stakes for the U.S., Mr. Hayward's guaranteed fortune won't strike many Americans as especially bad compensation for his few weeks of hardship in the Gulf. It's a bit hard to feel sorry for him.
www.christopherlane.org | After the Avandia Debacle, Big Pharma Gets a New Watchdog
- Thu, 15 Jul 2010 23:37:29 +0000
Yesterday was a rough news day for the pharmaceutical industry. For starters, a medical advisory panel at the F.D.A. recommended that Avandia, a controversial treatment for diabetes, be withdrawn from the market after repeated clinical trials indicated that the drug increased the risk of heart attacks. Avandia, made by GlaxoSmithKline, was once one of the world's best-selling treatments for diabetes.
The F.D.A. recommendation has attracted a lot of media attention, not just because of the drug's popularity and thus the enormous size of the patient pool, but also because the same advisory panel issued a different ruling in 2007, when doubts first surfaced about the drug's safety. In 2007, Gardiner Harris reports in yesterday's New York Times, "An advisory committee . . . decided that Avandia did increase heart risks but voted to keep it on the market." The revised recommendation prompted an editorial from the Times, "The Avandia Saga," which concluded: "The clearest lesson to emerge from the hearings and other recent revelations is that GlaxoSmithKline . . . can’t be trusted to report adverse clinical results fairly. The company must be watched like a hawk as additional trials that it sponsors go forward."
The saga continued to unfold today, with announcements that GSK plans to offset its legal woes with a $2.36 billion charge against its $8.4 billion in profits from 2009, as well as revelations that the drug maker was concerned about the negative rise of lipids, or fats, with Avandia as far back as the 1990s, but, according to Harris, "decided against just such a study because it feared that the results might hurt sales."
The news, both welcome and maddening, comes amid reports from worried physicians that patients who suddenly end treatment may be putting themselves at still greater risk. Indeed, the F.D.A. panel was split on how best to limit the risk of serious withdrawal symptoms from the drug. According to Harris, "Of the panel's 33 members, 12 voted that Avandia should be withdrawn; 10 voted that its sales should be restricted and the warnings on its label enhanced; 7 voted only to support enhanced warnings on the drug's label; and 3 voted that the drug should continue to be sold with its present warnings unchanged. One member abstained, and no one voted for a final option, to weaken the label's present heart warnings."
As GSK's legal problems include ongoing litigation over Paxil, a blockbuster antidepressant whose popularity also crashed after clinical reports of increased suicidality among especially teenaged patients, we are arguably witnessing pharmaceutical history repeat itself "first as tragedy, then as farce." For the FDA's 2004 ruling that black-box warnings be added to Paxil and several other antidepressants led to revelations, once again, that the drug maker GSK had withheld critical information about Paxil's side effects and withdrawal symptoms. Then, too, a large number of doctors weighed in with patient support groups on how best to spread accurate information about the drug without inducing panic and thus a dangerously abrupt termination of treatment.
If, like me, you find yourself scandalized and appalled that a drug company earning $8.4 billion only last year couldn't see fit to finance a proper clinical trial on the cardiovascular side effects of its blockbuster medication, then perhaps you'll be as relieved as I was when news also surfaced yesterday that a private company in Sydney, Australia, is fighting "to make pharmaceutical companies accountable to their customers by exposing information they wish to keep secret—information about the level of customer satisfaction or dissatisfaction with the drugs they sell and promote."
"Until now, the pharmaceutical companies controlled the flow of information to suit their business needs," observes Chris Ellis, CCO of the Customer Satisfaction Monitor (CSM), which uses Internet freedom, in the words of the company's founder, George Matafonov, to "empower consumers as the best defense against corporate excesses." The kind described above, for instance. Continues Ellis, "The Customer Satisfaction Monitor will change the dynamics of the pharmaceutical market for the better by ensuring consumers are better informed."
Based entirely on customer feedback over pharmaceutical products, the Customer Satisfaction Monitor is more open and transparent than are the chat groups and patient support groups that sprang up all over the Internet for those experiencing chronically adverse effects from popular drugs with spotty track records. The CSM is also designed to yield results without the bias and carefully selected data of advocacy groups, two-thirds of which, according to one global survey, rely on funding from drug companies or device manufacturers.
"Our research process reveals the average user experience and this is a far better guide to consumers than the research papers and studies often conducted and controlled by the pharmaceutical companies," says Ellis. "In effect, this feedback is the missing link in creating a truly informed pharmaceutical market."
Wary of the likely attempt by drug companies to post favorable comments and skew results under a mass of pseudonyms, I asked the company's CEO how it plans to prevent or offset such bias. Fortunately, he was one step ahead of me: "With regard to fake reviews we've developed what we call 'hotspot technology.' As consumer submissions grow a hotspot will develop on two charts that represent the average user experience. Any fake reviews, if they are inconsistent with the average user experience, will appear as an aberration. This provides a huge disincentive for anyone trying to influence the results unfairly. The truth about the average user experience will be self-evident and available at a glance on a chart, on an ongoing basis."
Consumers can also access the raw data and use a variety of filters to get a more complete picture of any product or service they are interested in.
"The focus of the Customer Satisfaction Monitor is not doing or analyzing formal research," its press release states; rather, through the aggregation of consumer data, "the actual user experience [is] expressed as a level of customer satisfaction. This is made possible by the connectivity of the Internet."
"Our biggest challenge," Matafonov concluded, "is to create the necessary awareness." To that end, I strongly encourage readers to check out the "decision portal" here: http://www.customersatisfactionmonitor.com/
Put the power of the Internet to work for you and get better informed about the drugs that have been prescribed to millions, despite shocking track records that the drug companies do not wish to share—not to the FDA, and certainly not to you, their potential customer.
To find out how GSK withheld key information about Paxil, visit www.christopherlane.org | Carl Jung's Frightening Demons
- Thu, 13 May 2010 23:39:11 +0000
One reason for the enigma surrounding Carl Jung's Red Book is that he never got around to finishing it. The haunting book ends mid-sentence, just after its author concedes, "My acquaintance with alchemy took me away from it . . ." It's a tantalizing end to a book full of riddles.
Jung's unfinished sentence isn't the only reason mystery has surrounded the book for decades. As Arnie Cooper notes in "Jung Confronts His Demons," a fascinating article in yesterday's Wall Street Journal, Jung's manuscript and paintings about communing with deities and demons (his own and those of others) were kept "in a locked cupboard in [his] Kusnacht house in the Zurich suburbs after his death in 1961." In 1984, Cooper continues, the manuscript "was transferred to a bank." Norton published it in translation only last October, almost exactly a half-century after its author had died. The book's editor and translator, Sonu Shamdasani, had spent five years trying to decipher and interpret the manuscript, and a further three trying to persuade the Jung family to allow him to publish it.
Although Jungians have been quick to downplay any suggestion that the book records more than its author's spiritual crisis or a foretaste of his evolving intellectual path, the book, which Jung christened Liber Novus (Latin for "New Book"), documents such matters as his conversations with the winged "Philemon" during his daytime walks. By that point, the Swiss psychiatrist had been treating schizophrenia for several years. And though Shamdasani insists that Jung was engaging in a controlled experiment—"There wasn't anything like a psychosis"—the wrinkle in that story is that Jung's unusual hallucinations appear to have been involuntary. Were they therefore signs of madness? Indeed, it's worth asking whether Jung today would be at risk of receiving the diagnosis "psychosis risk syndrome." The DSM-5 task force is currently formulating the term to include hallucations and delusions.
In one waking dream-state, Jung claimed to hear a bird-girl announce, "Only in the first hour of the night can I become human, while the male dove is busy with the twelve dead." At other moments, the influential thinker—either haunted by premonitions of the First World War or hyper-aware of the growing threat of European militarism—saw what Cooper calls a "landscape submerged by a river of blood carrying forth not only detritus but also dead bodies"—possibly a premonition of the devastation that would persist in Europe for the next five years.
Cooper's astute article doesn't try to settle either way whether Jung was mad or sane to experience such visions. His account of the book, as well as an exhibition at UCLA that's been organized around its thoughts and paintings (one of them reproduced above), is well worth reading.
www.christopherlane.org | How Schizophrenia Became a Black Disease: An Interview with Jonathan Metzl
- Wed, 05 May 2010 14:21:19 +0000
First, some preliminaries about your fascinating book, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon, 2010). How did you come to unearth such a trove of important documents at Ionia State Hospital in northeastern Michigan?
Ionia State Hospital for the Criminally Insane was, for much of the twentieth century, one of the nation's more notorious mental asylums, occupying an incredible 529 acres, and its annual census hovered above 2,000 patients. But, like many American asylums, Ionia suffered a rapid fall from grace in the late 1960s and early 70s, during the so-called era of deinstitutionalization. By 1974, the census was a paltry 300, and in 1975 the facility closed, then quickly reopened—as a prison.
That rapid transformation fascinated me. What had happened to the patients? What had changed? Why did the hospital become a prison? I spent a long time searching for the records, and ultimately discovered that much of the hospital's institutional memory—nearly a century of patient charts, reports, photographs, ledgers, and other artifacts—had been placed randomly in storage in the State Archive of Michigan, in Lansing. I spent another year gaining clearance from various review boards since of course the archive contains highly personal and confidential information, then spent the next four years reviewing the charts of over 800 patients.
What I found troubled me greatly. As I write in the book, "the charts documented in minute detail the tragedy of what it meant to be warehoused in a state asylum at mid-century—and, in particular, in an asylum where short court sentences devolved into lifelong incarceration. A number of charts contained yearly notes from patients to their doctors voicing such sentiments as Doc, I really think I am cured or Dear Doctor, I believe I am ready to go home, or, You have no right to keep me here. These letters stacked thirty-deep in some charts, signifying years of pleading and longing and anger, together with thirty years of responses from clinicians urging, You are almost there, or: Perhaps next year. Invariably, the last note in each stack was a death certificate from the Ionia coroner."
When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?
I found dramatic racial and gender shifts in persons diagnosed with schizophrenia at Ionia during the 1960s—so much so that schizophrenia's racial and gendered transformation became the central narrative of my book. This shift became apparent very early in my research. Before the 60s, Ionia doctors viewed schizophrenia as an illness that afflicted nonviolent, white, petty criminals, including the hospital's considerable population of women from rural Michigan. Charts emphasized the negative impact of "schizophrenogenic styles" on these women's abilities to perform their duties as mothers and wives.
To say the least, these patients were not seen as threatening. This patient wasn't able to take care of her family as she should, read one chart; another, This patient is not well adjusted and can't do her housework; and another, She got confused and talked too loudly and embarrassed her husband.
By the mid- to late-1960s, however, schizophrenia was a diagnosis disproportionately applied to the hospital's growing population of African American men from urban Detroit. Perhaps the most shocking evidence I uncovered was that hospital charts "diagnosed" these men in part because of their symptoms, but also because of their connections to the civil rights movement. Many of the men were sent to Ionia after convictions for crimes that ranged from armed robbery to participation in civil-rights protests, to property destruction during periods of civil unrest, such as the Detroit riots of 1968. Charts stressed how hallucinations and delusions rendered these men as threats not only to other patients, but also to clinicians, ward attendants, and to society itself. You'd see comments like Paranoid against his doctors and the police. Or, Would be a danger to society were he not in an institution.
Did the second edition of the DSM, released in 1968, have a significant influence on that shift in emphasis?
One of the key pieces of evidence I use to help explain the shifts seen at Ionia is through an extensive analysis of the changing language associated with the official psychiatric definition of schizophrenia. Before the 60s, psychiatry often posited that schizophrenia was a psychological "reaction" to a splitting of the basic functions of personality. Official descriptors emphasized the generally calm nature of such persons, in ways that encouraged associations with middle-class housewives.
But the frame changed in the 60s. In 1968, in the midst of a political climate marked by profound protest and social unrest, psychiatry published the second edition of the Diagnostic and Statistical Manual. That text recast the paranoid subtype of schizophrenia as a disorder of masculinized belligerence. "The patient's attitude is frequently hostile and aggressive," DSM-II claimed, "and his behavior tends to be consistent with his delusions." I have a lot of data in my book that shows how this language—particularly terms such as "hostility" and "aggression"—was used to justify schizophrenia diagnoses in black men at Ionia in the 1960s and 1970s.
How would you explain that shift, and would you view American psychiatry in those years as exhibiting either manifest or unconscious racism? Was it just coincidence that the DSM-II language enabled the diagnosis of schizophrenia among increasing numbers of African Americans?
That's a very important question. I argue extensively in my book that the purpose of my analysis is not to lay blame for individual racism, because I feel that such blame-games oversimplify what was going on. Many of the doctors at Ionia genuinely wanted to help their patients. I also talk to psychiatrists who worked on the DSM-II who told me that they were trying to do the best they could to produce scientific, objective diagnostic criteria.
At the same time, my evidence shows how even the most scientific diagnostic criteria can reflect the social environments in which they are produced, a process I discuss through the language of structural or institutional violence.
This was certainly the case for the DSM-II. As I show, the manual's emphasis on hostility and aggression reflected a much-wider set of national conversations and anxieties about civil rights. The shifting frame surrounding schizophrenia had dire consequences for African American men held at the Ionia State Hospital during the civil-rights era. More broadly, my evidence also shows that growing numbers of research articles in professional journals used this language to cast schizophrenia as a disorder of racialized aggression.
In the worst cases, psychiatric authors conflated the schizophrenic symptoms of African American patients with the perceived schizophrenia of civil rights protests, particularly those organized by Black Power, the Black Panthers, the Nation of Islam, or other activist groups. Ultimately, new psychiatric definitions of schizophrenic illness in the 60s impacted persons of many different racial and ethnic backgrounds. Some patients became schizophrenic because of changes in diagnostic criteria rather than in their clinical symptoms. Others saw their diagnoses changed to depression, anxiety, or other conditions because they did not manifest hostility or aggression.
How did the psychiatric profession characterize schizophrenia before the first and second editions of the DSM?
Insanity has a long and fascinating history. Before the advent of what we call "modern psychiatry," conventional wisdom had it that specific actions and life events caused specific types of insanity. Paupers Lunacy was thought to result from habitual intemperance, poverty, and destitution, treated by a diet of wholesome digestible bread and milk porridge, along with occasional topical bleedings. Masturbatory Insanity came from onanistic self-corruption and led to a form of idiocy manifest by sallow skin, lusterless eyes, flabby muscles, loose stools, and, of course, cold and clammy hands. And Old Maid's Insanity was, as the name implied, the insanity of old maids.
Two key figures helped to change the course of how we think about insanity. Emil Kraepelin was foremost among a group of European clinicians who defined insanity not according to causes or symptoms, but according to course and prognosis. In 1899, he coined the term dementia praecox to describe the "development of a peculiar simple condition of mental weakness occurring at a youthful age." And in 1911, Swiss psychiatrist Paul Eugen Bleuler argued that the underlying mechanism in praecox was a "loosening of associations," a process in which patients existed in the real world and at the same time turned away from reality ("autism") into the world of fantasy, wishes, fears, and symbols.
As an early proponent of Freudianism, Bleuler placed psychosis on a spectrum with neurosis as a developmental disorder with childhood origins. He maintained that the term dementia praecox should be replaced by a name that combined the Greek words for split (schizo) and mind (phrene). "I call dementia praecox ‘schizophrenia,' " he wrote, "because the ‘splitting' of the different psychic functions is one of its most important characteristics."
You make a powerful case for the way schizophrenia was transformed into a racialized disease at Michigan's Ionia State Hospital. To what extent can one extrapolate from that large psychiatric hospital broader trends across the country?
As a cultural historian and psychiatrist, I'm able to show how trends at Ionia reflect a series of larger cultural trends. One key literature that emerges in the 60s concerns the persistent race-based overdiagnosis of schizophrenia in African American men. For instance, in the 60s, National Institute of Mental Health studies found that "blacks have a 65% higher rate of schizophrenia than whites." In 1973, a series of studies in the Archives of General Psychiatry discovered that African-American patients were "significantly more likely" than white patients to receive diagnoses of schizophrenia, and "significantly less likely" than white patients to receive diagnoses for other mental illnesses such as depression or bipolar disorder. Throughout the 1980s and 90s, a host of articles from leading psychiatric and medical journals showed that doctors diagnosed the paranoid subtype of schizophrenia in African-American men five to seven times more often than in white men, and also more frequently than in other ethnic minority groups.
I also document in the book how associations between insanity and the civil rights movement played out extensively in American popular culture, and helped to shape the emergence of a much wider set of stigmatizations of schizophrenia—that it was an unduly hostile or violent disorder. I look closely at changing twentieth-century American assumptions about the race and temperament of schizophrenia through sources including American medical journals, newspapers, popular magazines, historically Black newspapers, studies of popular opinion, music lyrics, films, and civil-rights memoirs. I also reproduce unbelievable pharmaceutical advertisements that show angry black men protesting in the streets as ways of selling antipsychotic drugs.
I don't know if you're following DSM-5 developments closely, but there's been an enormous amount of controversy over "psychosis risk syndrome," which is being proposed for inclusion in 2013 as a way of improving the "early detection" of psychosis, especially in teens and children. Given the history you've unearthed about schizophrenia, are you confident that "psychosis risk" will function largely as the APA intends or are there likely to be unintended consequences if it's included in DSM-5?
Yes, I'm following this very closely. On one hand, I have to say that there is something very admirable about a profession that is willing to throw its entire diagnostic system up for grabs every fifteen years or so, and to seriously consider each and every word of its diagnostic bible. I also think that psychiatry has made great strides toward understanding the causes of mental disease, so in this sense the revision of the DSM represents progress on many fronts.
Yet history teaches us to be wary of language that might broaden diagnostic categories (or, in this case, might pathologize risk in addition to illness), especially when that broadening is not supported by clear-cut scientific facts. Also, it goes without saying that the language that appears in the DSM has tremendous implications for the lives of a great many people, patients and doctors both. Even in an era dominated by neuroscience, diagnosis remains a projective act—one that combines scientific understanding with a complex set of ideological assumptions.
You're a psychiatrist, and one who's critical of your profession's history, as is clear from both this book and your earlier one, Prozac on the Couch (Duke, 2003). How do you personally negotiate such professional tensions, and what in your opinion would help to narrow and alleviate them for other psychiatrists concerned about the state of their discipline?
Let me say, first, that in no way is my work meant to suggest that mental illness is socially fabricated, or, worse, that people's suffering is somehow inauthentic. As a psychiatrist, I have seen the tragic ways in which hallucinations, delusions, social withdrawal, cognitive decline, and profound isolation rupture lives, careers, families, and dreams in profoundly material ways. I know that such symptoms afflict persons of many different social, economic, and racial backgrounds, most all of whom are deeply aware of the sense of loss that their disease represents, even if society is less attuned. I also strongly believe that persons diagnosed with schizophrenia and other mental illnesses benefit from various forms of treatment or social support, and that our society should invest more in the care and well-being of the severely mentally ill.
I also believe that vigorous debate is good for psychiatry—both from outside the profession, and from within it. In previous eras, critics adopted a so-called antipsychiatric stance that advocated the near-overthrow of the profession. And to be sure, important critics still advocate for massive change. We know all too well from plagues past that the rhetoric of mental health and mental illness can become effective ways of policing the boundaries of civil society, and of keeping undesirable persons always outside.
But today you also see increasing numbers of scholars like myself who believe in the therapeutic and even potentially liberatory promise of the profession, while remaining deeply concerned about such issues as the impact of the pharmaceutical industry, the stigma surrounding diagnosis, and the expanded use of psychotropic medications, to name but a few.
I would like to think that books like mine help us understand how tensions that seem timeless or eternal—whether related to mental illness stigma, the overuse of psychotropic drugs, racial stereotypes surrounding psychiatric diagnosis, or even mistrust of psychiatry by members of minority communities—in fact result from particular decisions made at specific moments in time. I write in the book, "only during the civil-rights era did emerging scientific understandings of schizophrenia become enmeshed in a set of historical currents that marked particular bodies, and particular psyches, as crazy in particular ways. The tensions of that era then changed the associations that many Americans made about persons with schizophrenia. Ultimately, recent American racial history altered more than the meaning of mental illness: it changed the meaning of mental health as well."
Jonathan Metzl, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon Press, 2010). | Closeted Reactionaries
- Thu, 06 May 2010 21:51:19 +0000
Amid all the gasps of disbelief that one can hear over George Alan Rekers—Baptist minister, co-founder of the conservative Family Research Council, and vociferous advocate of ex-gay therapy—getting caught with a male escort after a holiday together in Europe, there are conflicting reports on whether the escort was there to help lift Mr. Rekers' luggage or to receive "the Gospel of Jesus," as the psychiatrist insisted recently.
With Rekers acknowledging that he found his bellhop from the male escort website Rentboy.com, and the escort now acknowledging that he was hired to give erotic massages, it's worth considering not only the astonishing disconnect between Rekers' private and professional lives, but also the incalculable damage his words about homosexuality have had on teens and young adults across the nation and beyond.
Until he was recently scrubbed from the organization's Website, Rekers sat on the board of the National Association for Research and Therapy of Homosexuality (NARTH), an organization dedicated to changing the sexuality of gay people. "Mr. Rekers," the BBC reminds us, also "has testified as an expert in favor of a gay adoption ban in Florida," for which he was paid $87,000 and during which he called gay men mentally unstable and a "deviant segment of society." His published works include Growing up Straight: What Families Should Know about Homosexuality.
While Rekers hardly seems like a good example of NARTH's so-called reparative theory, there's also something quite nauseating about figures like him "weighing in on almost every piece of anti-gay legislation around the country," as CNN puts it, and making the lives of especially young gays and lesbians more difficult, while he hires a male escort for a jaunt around Europe.
Dr. Rekers is now the butt of numerous jokes. And he has, one hopes, destroyed the very basis of reparative therapy for homosexuality—done so beyond any capacity for reform. When a prominent anti-gay activist is caught with a male escort, certain theoretical tenets about homosexuality either go out the window or come out the closet.
But Rekers is also, sadly, a textbook case of a long and sordid history of closeted gay men attacking their own while enjoying the same sex behind the scenes: Ted Haggard. Larry Craig. Roy Ashburn. Ed Schrock. To Roy Cohn and beyond. In this case, Rekers helped to write the very textbooks that have been invoked so often as arguing that men and women should be ashamed of being attracted to their own kind.
The shame belongs elsewhere. Rekers owes gay men and women across America a very big apology. If he won't come out of the closet, then he might at least agree to put down his pen.
www.christopherlane.org | Drug companies are pleading guilty to criminal charges, but even that's not enough
- Sat, 20 Mar 2010 16:36:20 +0000
In a well-timed piece that underscores the urgent need for health care reform and tougher legislation, the Washington Post today published a powerful investigative report on how frequently drug companies are breaking the law.
"Across the United States," author David Evans explains, "pharmaceutical companies have pleaded guilty to criminal charges or paid penalties in civil cases when the Justice Department finds that they deceptively marketed drugs for unapproved uses, putting millions of people at risk of chest infections, heart attacks, suicidal impulses or death."
Despite paying record criminal fines for their deception and negligence, the drug companies appear to have settled cynically on a policy of pushing hazardous products "off-label" on doctors and the public, with the expectation that massive profits will outweigh the inevitable fines and bad publicity.
You'll find the article here. Its evidence of malpractice is very damning, making clear to Congress that much-tougher legislation is needed to end such criminal practices once and for all.
www.christopherlane.org | Crazy Like Us
- Fri, 02 Apr 2010 18:54:27 +0000
"We are flattening the landscape of the human psyche," warns Ethan Watters in Crazy Like Us: The Globalization of the American Psyche. "We are engaged in the grand project of Americanizing the world's understanding of the human mind."
A bracing, thought-provoking read, Crazy Like Us is timely in light of current concerns about DSM-5, the soon-to-be revised fifth edition of the world's diagnostic bible of mental health. Drawing on several fascinating case studies, including of eating disorders in Hong Kong and of models of schizophrenia in Zanzibar, Watters argues that the model of mental illness the DSM advances has started to permeate and change how other cultures think about suffering, to the point of redrawing their social and psychological landscapes.
Is that a good thing? Might some elements of uniformity be useful, in pointing to shared patterns of distress? Or is a loss of cultural self-understanding the almost unavoidable outcome? In absorbing but troubling accounts of how PTSD diagnoses have come to proliferate in Sri Lanka and what the "mega-marketing of depression" has done for mental health diagnoses in Japan, Watters voices concern that well-meaning but mistaken Western psychiatrists have helped to export their conceptions of mental illness around the world. The outcome, according to Watters, is closer to medicalization—and banalization—than a helpful collation of knowledge and understanding.
With DSM-III editor Robert Spitzer acknowledging in Scientific American last April that his colleagues must now fight to "save PTSD from itself," it's worth asking: Are the definitions of disorders now daily invoked around the world sometimes faulty, even wrong?
That matter would seem to have acquired some urgency, as the American Psychiatric Association is moving to propose that "temper dysregulation" in children be considered a mental disorder. The organization also is listing as its first suggested criterion for the recently proposed "Hypersexual Disorder," "A great deal of time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior." Hopefully by 2013, when DSM-5 is slated to appear, the APA will have figured out what it means by "a great deal of time," especially because it's given a statement about desire in which most men, straight and gay, would recognize themselves. A sizeable number of women would, too. And isn't spending "a great deal of time . . . consumed by sexual fantasies and urges" a fairly good working definition of adolescence?
Related to the issue of accuracy is Watters' account of the consequences of exporting such models of illness, including by contributing to a massive spike in mental health diagnoses in Japan. As he shows persuasively, the key factor driving that spike was not a newly uncovered epidemic of disorders; the key factor was instead a concerted push by GlaxoSmithKline to market Paxil, its antidepressant, aggressively for diagnoses of social anxiety disorder. Watters underlines that GSK spent "an immense amount of money" to help create "Japan's First Mental Health Epidemic." A year later, the Wall Street Journal described such matters in a piece called "Waiting for Prozac: Drug Companies Push Japan to Change View of Depression" (Landers). As a result of such encouragement, according to the WSJ, sales of Paxil in Japan "reached ¥12 billion ($96.5 million) in 2001, its first full year on the market," and rose sharply in subsequent years. I found evidence of a similar practice of marketing new disorders after alighting on documents that revealed how GSK decided internally to push Paxil for social anxiety disorder in Europe and North America.
While researching my book on social anxiety disorder, I also came across startling but exasperating articles that sought to describe such large-scale phenomena as "Social Phobia in Saudis" on the basis of thirty-five outpatients, even as the author of that particular study acknowledged that "only 22 (63%)" of them had actually presented with social phobia" and that four of their files had been lost. The central rationale for such articles was determining how closely their patients' profiles fit DSM-IV criteria, a matter that would seem in many cases to beg the question rather than answering it.
That the DSM cannot be treated as gospel should long have been clear to its many readers (DSM sales since 2000 have exceeded $40 million). At the same time, Watters is drawing urgent and much-needed attention to the effects of its thinking, including most especially the consequences of all those millions of diagnoses. "We should worry about [a] loss of diversity in the world's differing conceptions and treatments of mental illness," he says, "in exactly the same way we worry about the loss of biological diversity in nature."
www.christopherlane.org
References
Chaleby, Kutaiba. "Social Phobia in Saudis," Social Psychiatry 22.3 (1987): 167-70.
Landers, Peter. "Waiting for Prozac: Drug Companies Push Japan to Change View of Depression," Wall Street Journal (October 9, 2002).
Watters, Ethan. Crazy Like Us: The Globalization of the American Psyche. New York: Free Press, 2010. | DSM and Disease: Dr. Ghaemi's Partial Answer
- Wed, 28 Jul 2010 16:28:04 +0000
I appreciate Nassir Ghaemi's partial answer to my earlier response to him, regarding the controversy surrounding DSM-5 categories and why the term "disorder" is destined to create confusion among psychiatrists. On that point I believe we're both in total agreement. "Disorder" is indeed a complex, ambiguous term that's often misapplied by psychiatrists in the hope that they'll give scientific credibility to traits and behaviors whose biological foundation is either unknown or nonexistent.
But while Dr. Ghaemi unsurprisingly reaffirms his commitment to think of psychiatric problems as "diseases," with radical consequences for mental health classification that he still avoids outlining, unfortunately he's thus far declined my invitation to specify exactly what the DSM-5 task force should eliminate from the world's diagnostic manual of mental disorders. Consequently, what follows in his response to me are a series of partial or non-answers, as well as a few inaccuracies and factual mistakes.
First, the whole business about Galen, Hippocrates, and other representatives of Greco-Roman medicine. The reason I wrote that Dr. Ghaemi's attempt to reclassify "disorders" as "diseases" would take us back to the age of Greco-Roman medicine is because several of his colleagues are most eager for such a return, and Dr. Ghaemi's enthusiasm for the concept of "disease" struck me as very much endorsing that move. In the early 1970s through the mid-1990s, as he surely will remember, the Armenian-American psychiatrist Hagop Akiskal, known for both his work on temperament and his hostility to "soft-headed" or "pseudo" psychiatry, announced that it was time to update Richard Burton's Renaissance study The Anatomy of Melancholy (1621), not by moving forward but by turning the clock back to the age of Galen, Aurelianus, Soranus, and yes Hippocrates. Why? Because Akiskal thought that the "four temperaments" orienting medicine in the Classical age—the sanguine, melancholic, choleric, and phlegmatic—have "a very modern ring to them."
Ironically, then, while Dr. Ghaemi's colleagues were busy heaping scorn on terms like "neurosis," because they didn't have an obvious biological foundation (indeed, precisely because they pointed to nonbiological forms of distress and suffering), the very scholars he echoes today in preferring "disease" over "disorder" were busy validating theories millennia out of date.
Second, Dr. Ghaemi asserts rather amazingly in his response to me, "There is no link, direct or indirect, between Pharma and the basic structure of today's psychiatric nosology, as set in DSM-III in 1980." Um, I'm guessing Dr. Ghaemi skipped the part of my book on DSM-III where Isaac Marks, the world-renowned expert on fear and phobia, relayed to me how Panic Disorder found its way into the third edition of the manual. According to Marks, who was present at the occasion, the CEO of Upjohn Pharmaceuticals, maker of Xanax, opened a key Boston conference on panic by saying, "Look, there are three reasons why Upjohn is here taking an interest in these diagnoses. The first is money. The second is money. And the third is money" (qtd. p. 74 of Shyness).
That's just one rather glaring instance of the mutually beneficial relation between psychiatry and the pharmaceutical industry that has beset the profession since at least the 1980s, and arguably quite a few decades before. Unfortunately, the American Psychiatric Association required DSM consultants to declare conflicts of interest with Pharma only in subsequent editions, after DSM-III had formally approved the existence of 112 new mental disorders in 1980. As Dr. Ghaemi knows, large numbers of his colleagues continue to serve as paid consultants to upwards of two-dozen pharmaceutical companies. Is he really trying to convince me, with a straight face, that such large sums of money (plus the odd trip to Hawaii and the Bahamas) haven't, um, "influenced" their enthusiasm for pharmaceuticals just a bit? Even when their tenure as professors relied substantially or even exclusively on such funding?
Third, Dr. Ghaemi confuses me with a group of antipsychiatrists whose efforts are aimed at undermining the concept of disease altogether. That's a mistake on his part and far from an intention on mine. "Consider the rest of medicine," Dr. Ghaemi exhorts, "and tell me that there is no such thing as disease. If not the diseases of cancer and coronary artery disease and stroke, what are the ethereal conditions that kill people right and left?" Indeed, the list of other medical diseases or conditions is vast and beyond dispute: Aids, Alzheimer's, angina, arthritis, asthma . . . the list is clearly long, even if we stay with the letter "A." Our debt to modern medicine in finding full or partial remedies for such conditions is similarly vast.
But since Dr. Ghaemi began this discussion by outlining his frustration with the term "disorder" in its psychiatric context, where the concept of disease is (as he knows) far more controversial; by declaring that American psychiatry was practising "an exercise in self-delusion" in claiming that it was being agnostic over etiology; and by personally offering to start "a surgical process of excision" to pare back the burgeoning diagnostic manual, I'll end by restating my invitation that Dr. Ghaemi make good on declaring which "disorders" in the DSM should go. These were his exact words: "One approach would be to add about 50 other such common non-disease clinical conditions. All other problems with psychological symptoms, most of which probably represent problems of living rather than diseases, could be left out of any diagnostic definitions."
As I wrote in reply, which 50 "common non-disease clinical conditions" should stay? And which "other problems with psychological symptoms" did he have in mind?
Let me be clear that Dr. Ghaemi and I are in total agreement about the urgent need to reduce the size of the world's diagnostic manual of mental disorders. If the editorial knife were in your hands, Dr. Ghaemi, where would you start making your surgical excisions? Let's get that debate rolling. It's really long overdue.
References
Akiskal, Hagop S., with William T. McKinney, "Psychiatry and Pseudopsychiatry," Archives of General Psychiatry 28.3 (1973), 367.
Lane, Christopher. Shyness: How Normal Behavior Became a Sickness. New Haven: Yale University Press, 2007.
www.christopherlane.org |
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ORGANIZATION GUIDE
INTRODUCTION
When people go to a church
and start talking in tongues, they don't have any idea what they are
saying and neither does anyone else. However, such behavior and other bizarre
acts as talking to and seeing Angels that no one else can see or hear is
both acceptable and desirable within a religious setting.
Should someone
have similar experiences outside of a religious setting, however, they could
easily be called schizophrenic and locked away indefinitely.
The key
difference is in the write up or the nomenclature used to describe the
experience. While humans have had access to alternative states of consciousness
for countless thousands of years, it is only in relatively recent times that
scientists have sought to limit the ability of humans to experience other states
of awareness by specifying what they feel is normal and what is not and
by setting up an enforcement system backed by the force of law to hunt down
people whose state of consciousness they disagree with and lock them
away.
Click Title for more...
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Neither pro- nor anti- medication, the guide provides valuable information for making wiser decisions, and supports people coming off as well as staying on meds. It was developed with the editorial involvement of 14 health care professionals, including psychiatrists, registered nurses, and acupuncturists, and published by The Icarus Project and Freedom Center. You can find out more about the Guide by clicking on the link in the Title. PLease make sure you scroll down far enough.
Harm Reduction Guide PDF Download
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Special People and Places
In June 2006, Leonard’s Electroshock Quotationary, was published on the Internet. The book is an illustrated, 154-page collection of chronologically arranged quotations, excerpts, and short essays about the history and nature of electroshock (electroconvulsive treatment, ECT), psychiatry’s most controversial procedure. This is a PDF file.
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Newsweek: The Growing Push
Listening to Madness
Why some mentally ill patients are rejecting their medication and making the case for 'mad pride.'
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PsychDiagnosis.Net
by Paula J. Caplan, Ph.D.
Many people have presented me with the following challenge: ‘People suffer. Often, good therapists can help relieve suffering, and suffering people deserve to have insurance pay for their therapy. But insurance companies won’t pay unless the person gets a psychiatric diagnosis. However, psychiatric diagnosis is unscientific and has often caused both direct and indirect, devastating effects in people’s lives. So what is the solution?”
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S O C I O L O G Y
F O R D E M O C R A C Y
WRITINGS AND TEACHINGS
KENNETH WESTHUES
Professor of Sociology
University of Waterloo, Ontario N2L 3G1, Canada
519.888.4567, ext 33660
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Updated with quotes for January 2010:
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Classic:
Enlighten the people generally, and tyranny and oppressions of body and mind will vanish like evil spirits at the dawn of day.
— Thomas Jefferson, letter, 1816.
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Schizogenesis
The Mobbing Encyclopaedia
The Definition of Mobbing at Workplaces
© Heinz Leymann - 12100e
Bullying; Whistleblowing
Mobbing - its Course Over Time
New Literature
© Heinz Leymann - file 12220e
Identification of Mobbing Activities
© Heinz Leymann - 12210e
MOBBING: Emotional Abuse in the American Workplace
"Read this book as a safety manual for avoiding the most terrifying kind of workplace injury. The advice given here is clear, practical, and sound. Its foundation in empirical research is firm. I recommend this book to every employee and manager in America."
-Dr. Kenneth Westhues, Professor of Sociology, University of Waterloo, Canada, author of Eliminating Professors, A Guide to the Dismissal Process
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