Impressive Work!

Hello Dearest Students,

For the last five weeks I have tried to expose you to material that is out of the mainstream, to provide you with a perspective that may be different from the conventional MI content. I have refrained from traditional "teaching" because I believe in facilitating learning rather than telling you what you need to know. Sometimes if instructors participate in online discussions, this creates a hawthorne effect, which may bias commentary from students in a particular way. This is why I have not responded to your posts.

I want you to know that  I am deeply moved by your posts and replies. From my perspective, many of you have explored ideas that may not have occurred to you before. That, in an of itself, makes my job worthwhile.

I am so impressed by the student realization that the Pro-psychiatry v. Pro-recovery is a false dichotomy. That it is. Psychiatry in its best form, provides psychoeducation, TRUE informed consent, and person-centered, individualized planning. Herein lies the conundrum. At this point in time, there are between 30-100 neurotransmitters in the central nervous system, I have read a specific number of 54. Researchers have linked some of these neurotransmitters to symptoms (e.g., dopamine, serotonin), but do not yet understand how these actually work. If you are familiar with the mathematic concepts of permutations and combinations, when you have 54 potential variables, and you target two of them, there are many many combinations possible. Add to this individual differences in brain chemistry, and frankly, anything is possible. This is why, in my opinion, that medications are a "crap shoot" in terms of efficacy for managing symptoms. This is also why I think practitioners should be honest about what we "know" about these medications and their effects on the brain, both good and bad. Then, and only then, is there truly informed consent.

So, I am FOR psychiatry that offers real help to people, and is honest about what we REALLY know about medications and the brain. If you look closely at any antipsychotic medication pharmaceutical handout, or Physician's Desk Reference (PDR), it may surprise you to find that the description states "actual method of action unknown."

Medications CAN help people, and medications can bring lots of bad effects as well. At least the DSM5 finally acknowledged "discontinuation syndrome," so when people go off meds, or switch from one to another, people know that the brain zaps and other weird symptoms are part of the withdrawal process. Prior to DSM5 many consumers were told that antidepressants were not addictive. Now we know better. I believe people should be able to choose whatever level of treatment they feel is best. However, without being told the real potential outcomes of the treatment, there is NO informed consent. For example, someone was told that ECT is like putting a 9 -volt battery up to your head. This, to me, is not informed consent. Many docs are quite cavalier about the treatments they prescribe, and this needs to change.

Community support, employment and/or meaningful activity, housing, and the presence of at least one person who loves unconditionally -- these are the ingredients to recovery. Good health care and pro-recovery psychiatry should also be part of the supports in the community. I truly believe that if we are honest about what we know and don't know about mental illness and its treatment, and present ourselves with an authentic willingness to help, we can help people alleviate their pain and live their best, self-defined lives.

Our responsibility as educators and practitioners is to reflect regularly on what we think we know, and what we actually know about mental illness. The best teachers to support this reflection are people who have mental illness...This I know.

I have so enjoyed reading your responses, and I thank you for your work. You give me hope!

~ Dr.B.

THE ANTI-PSYCHIATRY CONTINUUM

Some practitioners have been publicly critical (and then ostracized) for their antispsychiatry views. In your readings, you have encountered Loren Mosher and Peter Breggin.  The Director of NIMH came out against the DSM 5 in 2013, saying that the organization should no longer fund research based upon DSM diagnostic categories. Story here:

https://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5

It seems there is a continuum of support for the medicalization of mental illness. One one end of the continuum there are anti-psychiatry folks like Breggin (who are totally opposed to using diagnoses AND medications), and some psychiatric survivors like Ted C. Others take more moderate approaches (Anthony, Deegan, Chamberlin) and may question the validity of diagnoses, but in general, don't object to the use of medication, if it is helpful for folks. they would be in the middle of the continuum.  On the other end of the spectrum are folks who take the recipe-book approach to diagnosis and treatment with medications, ECT, cingulotomy, and capsulotomy. "This diagnosis gets this treatment."

Not all psychiatric survivors are radically anti-psychiatry, and not all practitioners are pro psychiatry.  Do pro-recovery principles qualify as anti-psychiatry? Can you be pro-recovery AND pro medicalization/psychiatry? Or is this a false dichotomy?

Where do you fall on this continuum of "antipsychiatry?" Describe your rationale, then comment (respectfully) on at least one of your classmates' replies.