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.
Since taking this course, I think I more closely align with the anti-psychiatry notion. I’ve always been kind of turned off by the medical professionals across the board anyway. Whether a primary care physician, counselor, or psychiatrist, I don’t like the idea of a “professional” having that much power over me. We so often see the damaging effects of assigning a diagnostic label. To me it would make seeking out help so unappealing, especially for some kind of emotional disturbance. Even if practitioners wanted to explore alternative ways of viewing or treating mental health disabilities, they are so often confined to the rules of the medical model of treatment. A diagnosis must be assigned in order to bill insurance companies. It’s sad to think that in order to get help (I use this term loosely) in our culture folks must subdue to their disability. A mental health diagnosis must become one’s prominent identifying feature. If people with mental health challenges are in anyway resistant of this label or traditional forms of treatment they are considered non-compliant and often the recipient of forced hospitalizations. I do like the idea if recovery, in that it is the person with mental illness responsibility to get well instead waiting for something to be done to them by a medical professional. It is promising to read about effective recovery oriented forms of treatment that do not prioritize or even consider the use of medication. I’d be interested to find out if a person with a psychiatric disability in the Bangor area articulated that they want recovery oriented form of treatment with no medication, what type of response would they get? Would they just end up in Acadia or are there options locally? I guess I’ll have to find out.
ReplyDeleteIn theory, people have a choice about whether they take medications. They have a right to refuse and need to actually consent in order to be given medications. There are situations in which those rights may be infringed. Legal guardians need to also sign consent for medication, but a person-even a teen-can still refuse to take medications, even if the guardian has signed consent. Having said this, I also feel like people experience a lot of coercion and "force" around medications. When people choose not to take them, they are often viewed as non-compliant and probably higher risk to be hospitalized.
DeleteGeoff, you are correct in asserting the insurance companies restrict methods of treatment because of billing purposes. I wonder if practitioners would be more amenable to alternative treatments if they knew they would be reimbursed for it.
DeleteGeoffrey, you make some really great points regarding anti-psychiatry and treatment that does not allow for client-choice. I would agree that a practice that does not allow for client-choice would be highly unappealing for those seeking help and would make them avoid it entirely. I would also say that many people currently do avoid treatment for that reason; they believe that seeking help means giving up choice and surrending to the inclinations and expertise of their doctor or counselors. And while I think there can be some relief when it comes to giving control over to someone who may have more insight into helpful treatment it should not come at the expense of client choice. Rather there should be a partnership and team effort in terms of the client's treatment in which the doctor/counselor offers options and information and the client ultimately makes the choice.
DeleteYou additionally raise valid points and important questions with regard to treatment requests, diagnoses requirements, and billing and insurance policies. I don't know a lot yet about these issues but I do know that too often finances and policies play a more significant role in a client's treatment than it should. This is another area that requires more advocacy, education, and legislative work on the part of mental health experts.
It is interesting to think about this anti-psychiatry continuum. I believe the anti-psychiatry end of the continuum, including some of the moderate opinions, are more apt to take a pro recovery approach. I think as you move down the continuum towards medication and more rigid treatments it becomes more about managing symptoms. I would not want to make the assumption that all professionals who take the pro medicalization/psychiatry approach are against recovery. Perhaps they believe this is the route to recovery...I'm not really sure. I think that nature of recovery means feeling empowered, supported, accepted, hopeful and in charge of your own existence. It seems it would be harder to feel all of these things when you are not really in charge of your own treatment. I think a lot would hinge on the attitude of the professionals and how supportive they are of making sure the individual is empowered to be in charge of their goals. The reality, I suspect, is that the two ends of the continuum do not intersect that successfully.
ReplyDeleteI think that I fall somewhere in the moderate to anti-psychiatry end of the spectrum. Having worked with quite a few folks with mental illness it's hard to dismiss the role medication can play. I have heard a lot of folks who have found their medication to be a valuable tool in life that helps them feel better. I hate to see it be the first and only line of defense and I think unfortunately it has been in a lot of cases. I think that medication and symptom management have become such a prominent part of society that it sadly may be hard for some people with serious mental illness to believe recovery is possible. So I am really drawn to different approaches that offer hope and empower and value the individual as a whole person.
Informed consent, whatever the treatment, is vitally important. People should be given options with information about risks and benefits. Teams should work together to gather and provide information and education. Providers should be up front with people about their own beliefs and biases. The individual should then make decisions about what best meets their needs. I also fall in the middle and have also seen medication when used as one tool be very helpful for some people.
DeleteSandra, I really like your use of language and words such as "empowerment, support, acceptance, and hope" with regard to the concept of "recovery". I would agree that these are essential elements of recovery and true recovery cannot come about without these elements. That said, I would also add that in the path to recovery a client must also be allowed to choose to utilize medication and psychiatric methods should they deem them helpful and necessary. And the mental health worker would be responsible for informing them of all of the effects of doing so and would also provide input on potential helpful options for weaning off of these methods as needed and where possible.
DeleteWhen I look at the continuum I find both absolutes of psychiatry and anti-psychiatry lacking. I believe that falling in the middle creates a more rounded treatment experience. I think medication and labels can play positive roles in people's lives just as they can create barriers. I have friends that still identify themselves as having Asperger's even though it was removed from the DSM and see the diagnosis as a positive thing that helps them connect with others. Labels and diagnoses can also put people in boxes when it comes to treatment and societal stigma. I believe that the pro-recovery principles are becoming more common in treatment with or without medication. I think practitioners can work with individuals and use interchangeable treatment methods to best serve patients even though not every practitioner does. Absolutes are not viable when it comes to treating mental illness, and I think having a open mind is the best tool a practitioner can have when it comes to treating people.
ReplyDeleteMichelle, I think you are probably right when it comes to not viewing psychiatry in absolutes. I think the anti-psychiatry movement is valuable though. When people with MI and practitioners become aware that there is an opposing philosophy and treatment modality, people are able to consider something new which may have been considered farfetched at first glance. Without Anti-psychiatry we have no middle ground. Psychiatry has throughout history and continues today to dominate the diagnosis and treatment of mental illness. It’s good to learn that this domination is being challenged, so people with mental illness can advocate that their treatment be more individualized. I do believe that in most cases still, an anti-psychiatry approach will earn you the non-compliant label removing your voice when considering treatment options. So I think there needs to be anti-psychiatry people to level the playing field.
DeleteThere is a lot to ponder when determining what works best in treatment for mental health diagnoses. I find myself more in the middle of the continuum. I support recovery and believe people should be in charge of their mental health. With the right to govern your treatment comes the responsibility for it. People continue to be viewed in a negative light in many cases when they do not comply with treatment prescribed by the experts. This is unfortunate. I think people have expertise in their own experiences. In terms of diagnosis and DSM, there are some benefits to classifying symptoms into diagnoses for purposes of understanding better what people with these sets of symptoms tend to experience, but it is important to use diagnoses as a tool to promote understanding of a person' mental health. The problem with DSM is the stigma attached and the rigid manner in which it is applied.
ReplyDeleteMedications are one tool. There are many other treatment options beyond medications. There are also many medication options. People should be offered information about risks and benefits and should be free to make decisions about what works for them. Providers should assess, provide psych-education, and support.
Toni,
DeleteYou are right on with the use of informed consent to educate and allow for real choice. It is so important to know what choices are available and how to access them. Medication may just be one tool which can be used in conjunction with other therapies and perhaps reduced as health increases.
I agree with your perspective that medications are a tool and there are many other treatment options out there. It seems like providers are so rushed to see a patient in the allotted 15 minutes per appointment and/or have to comply with insurance company demands, that short cuts are taken, medications are the quicker solution, or the physician simply isn't educating the patient of options. In this day and age, however, people have tools to educate themselves and advocate for loved ones (if they can get thru our society's red tape.
DeleteIf we could, as a society, reduce stigma associated with mental illness, I think we would find the idea of people having a voice and choice in their treatment would be better supported. Too often, people diagnosed with mental illness still seem to be viewed and treated as incompetent and therefore incapable of being part of decisions. Psychoeducation of individuals and their support systems-family, friends, and community can make a big difference.
DeleteHi Toni.
DeleteYou make an interesting point about the responsibility of the person in their own treatment. I wonder if we hold people with mental illness to a different standard? If I am diabetic I can indulge in eating sweets and tweak my medications without societal looking down on me for it. A person with mental illness is deemed non-compliant if they decided they did not want to feel like their brain was in a fog and not take their medication.
There are many side effects with psychiatric medications ranging from annoying to dangerous. Feeling like your brain is in a fog is definitely unpleasant and not worth it for many people. I think people have the ability to be responsible for making decisions that work for them, but they often don't see it that way because of how our system works. I believe people can and will make decisions that work for them when they have the information and support they need.
DeleteI agree that patients should have a say in their own treatments for mental illness. There is a responsibility of the individual to advocate for themselves if they do not want to follow the treatment of their doctor. The stigma of mental illness can hinder that by making the individual seem non-compliant while they are asking for another way to help them recover and retain a healthy life. I think people get stuck with the idea that the doctor is always right, when they are biased by their own opinions and beliefs like the rest of us. When individuals are stuck with one doctor because of money, location, or availability it leaves them at a disadvantage without choice if it isn't the right fit.
DeleteToni, I really appreciate your points regarding diagnoses and the use of the DSM. I would agree that it can help one better understand what might be happening for a patient and can help a person narrow potential helpful treatment modes. And it is definitely necessary to find a balance and to not merely rely on the DSM and a diagnosis as the end-all be-all method for choosing a treatment option. Rather the DSM and a diagnosis can be tools used and weighed against all information and factors for each individual client. I would also agree with you and others that it is important for the mental health worker to provide education and information and that the client has a responsibility to explore this and all information possible as they make determinations for themselves. The scary part with this though is that many people do not even know where to begin with this and may not have access to all the necessary and appropriate resources and information needed to access appropriate treatment. In rural areas of Maine, in particular, this may become even more challenging. And even when people have access to resources and information, they may not pursue the necessary supports due to various stigmas associated with mental health treatment. This again is where it comes back on us as mental health workers to find ways of making treatment palpable as well as accessible.
DeleteTonight, I find myself in a moral conundrum regarding the pharmaceutical companies and psychiatric disorders. Pharmaceutical companies donate large sums of money to the American Psychiatric Association, the National Alliance for the Mentally Ill, and Psychiatric Practitioners, along with medical facilities according to reports presented by Dr. Loren R. Mosher. I felt sickened when I read these articles and thought of all the people who have and may continue to suffer because there are dollar signs attached to their backs.
ReplyDeleteI have seen medication work effectively for depression, premenstrual dysphoria disorder, anxiety, and schizophrenia but have I given the time and effort to see anti-psychiatry work effectively? I am not sure where the sickness lies. Are we medicating sick people to be well or are we medicating sensitive people to appear healthy in a sick environment?
The examples of the Soteria Project make me question my own beliefs about health and quality care. My coworkers and I are noticing more and more youth who present with anxiety. Could it be that our environment is making youth unhealthy? We do not seem to be in a place that we can slow down and many of us are in a perpetual state of rigger. Our computers are faster, we have more screens to multi-task, we have phones that can do everything. Can our human being take the constant assault of a human doing? Are we drugging ourselves to stay current and functional in a dysfunctional world?
I can respect and appreciate the recovery movement, dislike medication, and fully embrace medication. This is messy, non-linear, and human. Some people are walking an ethical tightrope while others are fueling on greed and deceit, most of us try to be ethical. We get caught up in the fast pace and lose our way but it is a loop for most of us.
I am pro- recovery of healthy, inclusive communities.
WOW this is a great response Liz and I enjoyed reading it a couple of times as you touched upon so many significant factors that seems to summarize the reality of it all. Cause and effect... money/greed, environment/bad health, fast paced/anxiety, technology/expectations, diagnosis/medication.
DeleteSuzanne,
DeleteA less kind and diplomatic person could say that I have tangential rantings but I appreciate your view. I was really impacted by the readings and the fact that I have recently had trainings in the Dorothea Dix psychiatric Center. Every time I walked past her picture, I imagined her not speaking about her efforts because she believed she had failed. Dorothea Dix, you mattered!
Hi Liz- you raise many excellent points. I think it's a good thing for us to experience horror and worry over practices for those with mental health diagnoses. I have also seen medications be effective at times, and i also dislike and embrace medications. It's a dilemma. It's important to question things when we feel conflicted because asking the questions prompts continued thought, assessment, and ultimately better services for people.
DeleteHi Liz,
DeleteI really enjoyed reading your post particularly when you mention the multitude of fast-pace changes to our society. What are our expectations for ourselves and fellow human beings these days? Cultural factors are a huge component to this discussion. I do not feel educated enough on the approach that other cultures take in regards to recovery and psychiatry, but I'm sure there is a lot of variation. The amount of pressure we place on ourselves and others is growing. But for what? And at what expense?
With the majority of my career working with people on Short and Long Term Disability, it was easy to notice those physicians who treated the diagnosis as opposed to the whole person. This was especially prominent during the initial visits with the claimant’s primary care physician (PCP), who understood general medicine and not psychiatry. It was sometimes frustrating to see in the medical records how the PCP would try this medication, then that medication with no referrals to a psychiatric specialist.
ReplyDeletePreventing a disability mindset is difficult once out of work for a longer period and not being under appropriate treatment with a medical professional who understands psychiatry.
I do feel pro-recovery principals lean towards the perspective of being anti-psychiatry as they do not place an individual into one diagnostic category and will view medications an option or tool. Since there are so many variables that can cause psychiatric-like symptoms, which can sometimes just be treated with understanding a life event, physicians should be open to these principals. I realize they must place a diagnosis code to an appointment to submit to the insurance company, which is strictly a financial transaction, not a treatment plan.
I fall in the middle of the continuum as I favor understanding the whole person and their capacity and not a symptom or diagnosis. I do feel some medications are helpful for many people, sometimes only needed for a short period of time for an acute situation. I do not think it is the answer for everyone, thus opposed to cookie-cutter treatment when someone is sad, anxious, and/or hearing and seeing things. As we read in many personal stories, once the person understood things about their life or an event, sometimes that was all the treatment they needed.
Hi Suzanne,
DeleteI value your reiteration of the "Whole Person" being treated. None of us are symptoms and many of us react to life events and therapeutic tools very differently. I don't think I am in the middle of the continuum because I have very strong opinions based on the age of the client and the range of therapeutic interventions used. I think child should always be assessed for diet, sleep, and physical activity prior to medication. I also believe that most Americans are not sleeping at night because of too much caffeine and lack of exercise. I think our American lifestyle is creating illness that may be treated as a psychiatric disorder.
Liz your perspective is making me question mine, in a good way. I am also thinking our lifestyles are creating illnesses and have witnessed that with family and friends. Hmmmmm, thank you for your opinions related to this!
DeleteLiz and Suzanne- This is such an excellent point. I think it is very important to treat the whole person and to assess all aspects before jumping to medication. Once the decision is made to use medication, it is often hard to stop so it shouldn't be done quickly.
DeleteSuzanne - I thank you for your points. Your points about pro-recovery principles leaning toward being anti-psychiatry ring true for me in that you use the words "lean toward." I absolutely agree that they lean this way but that the two do not necessarily have to be separate. Rather it is important to listen to and empower clients in their path to treatment while celebrating a sense of community and also allowing clients to utilize all other tools available including medication and psychiatry should they deem them helpful and necessary.
DeleteAnd Liz, I'm so glad you bring up American lifestyle and the very real issue that it may be creating issues that we treat as psychiatric disorders. Many people struggle with stress and depression that is caused by or at least exacerbated by work schedules and environments, sedentary lifestyles, unhealthy eating, lack of exercise, etc. When people are merely medicated to address depression, weight issues, etc. it does not actually correct the real issues and does not provide true recovery. It is important to approach medical and psychiatry treatment paths with caution and to use them as needed while also using other methods that get at the true cause of the issues.
The extremes of each argument represent two differing ideal situations. The caring and small community settings that promote relationships over time. And the other extreme where the medical model is applied attempts to fix broken people through medication or other means. What I have learned over time is that ideal situations do not readily apply to most situations which are usually complicated. It is like trying to place a round peg in a square hole. I think pro-recovery and pro medicalization/psychiatry can be reconciled. The pro-recovery advocates are hyper vigilant to the abuse they have experienced at the hands of the pro medicalization/psychiatry. When people with mental illness are respectfully listened to and have choice, that is when the best of each side of the argument can really apply their strengths to the benefit of the person with mental illness. I fall in the middle of the antipsychiatry continuum. Cautiously acknowledging that medication works for some, but also acknowledging its limits and knowing as complex organisms many variables need to be taken into account, such as their personal history, environmental factors, or maybe a person’s diet, just to name a few. I do regret that the Soteria House model has not been studied further or been given more credence. Mosher is more right than wrong in his accusation of psychiatry and “Big Pharma” scheming together. Much abuse of the mentally ill, I believe, is due to the system meant to care for them is stressed to the point it is run like an assembly line – get people in and out as quickly as possible to treat the next person.
ReplyDeleteHi Ken, I am not sure what the solution is but I see a recurring theme of bad things happening when people are linked to profits. No one made any money on the Soteria House but lots of businesses and individuals are getting rich off "Big Pharma".
DeleteHi Ken, I thought you made some great points and I certainly agree with your assessment, especially saying: "The pro-recovery advocates are hyper vigilant to the abuse they have experienced at the hands of the pro medicalization/psychiatry." I think it is a very natural reaction for individuals who have experienced/witnessed this abuse to stake out a 180 degree position. As you said, only when individuals are respectfully listened to and have choice will they be able to have both sides of the spectrum work in their best interests.
DeletePro-recovery principles are not mutually exclusive with the principles of psychiatry. One can be a champion of recovery, and simultaneously use medication (Deegan, as an example). One aspect of recovery and empowerment is that the individual's choices matter, their perspective matters, and they are accountable to themselves. If one chooses to use pharmaceutical substances as a part of their recovery, they do so as an individual choice. Just as those who work the 12 steps will not utilize tools that do not further their recovery, and will eschew things that are a detriment the recovery process, so should those in recovery from mental illness.
ReplyDeleteI do not think, however, that you can be pro-recovery and pro-medicalization from an absolutist philosophical vantage point. That is, those who are deeply pro-establishmental/medicalization of recovery do not accurately comprehend that recovery is about individual choice... even when it comes to medications. Especially when it comes to medications. So, yes, there is an inherent illogical quality to the idea that someone is pro-recovery and pro-medicalization.
My vantage point is one that takes the long view. I view this as a tiny blip on the map of human history. I do think that the chronic use of medicine over prevention and recovery through other means is truly barbaric. I've said it before, but the shear lack of evidence that these things work more than placebo or better than lifestyle and social changes makes me regard them as 1.) unscientific, and 2.) missing the point entirely. The field of psychiatry reminds me of snake oil salesmen in the early part of the 20'th century. Or perhaps the bread and circus of the Roman empire. Numbing/distracting the minds of the plebeians so that they would not cause trouble. Today, the multitudes of "ADHD" diagnoses, depression, anxiety, bipolar, etc, diagnoses, all point to a problem with the system, not the individuals. The solution of psychiatry is to medicate. My personal view is that it is a society/culture-wide social, economical, and spiritual problem. And empowerment for recovery seems like the only viable solution, with or without the assistance of medications if the person who takes them is informed and so chooses (otherwise, its not recovery).
Hello Shea, Your last sentence holds a lot of power because it can only be recovery if the person is empowered which begins with informed consent and accurate, informed choice. When I go to a doctors office, I leave with a small amount of knowledge based on the large amount of information that is given to me. I wonder how much our clients leave with and how we can relay information in a more receptive way? I am wondering if "informed consent" is often a check box to cover a procedural directive rather than a clear sharing of information. I luckily am not in a position to prescribe medication but I have the opportunity to meet with clients to develop a plan for recovery through employment and employment related activities. I see people who are involved with many treatment modalities which involve medication and therapy, now I am wondering if my clients have informed consent or if they just sit through spiels?
ReplyDeleteHi Liz
DeleteInformed consent it a fascinating concept. To me, it feels like when you really dig in, that it almost never is actually upheld in principle. Take one's PCP, for example. This relationship between a patient and the PCP fully exemplifies the standard of care in medicine- we the patient go to the expert to seek an answer. My experience is that the answer- perhaps an Rx for a medication- is never fully explicit. I personally have to ask my PCP what the side effects are, and they typically dismiss the profile as "oh, just a little of this or that, but its rare".
There is an element of deference and hierarchy in the relationship. "I say, you do. I tell, you know." If you don't think to ask, and they don't offer to tell, then how does one know? How can consent be truly informed if the meme for the relationship is one where doctors/psychiatrists are poised in our collective thinking (a holdover from the Progressive era in the early 20th century, but that's another story...) to regard ourselves as those who know nothing, and the doctor as the unequivocal expert?
I am fairly comfortable taking the stance that this dilemma is a false dichotomy. I think – like most things in life – keeping an open mind, moderation and balance are key. In the age of person centered planning and individual treatment plans or approaches, embracing pro-recovery principles such as uniqueness of the individual, real choices, attitudes and rights, dignity and respect, partnership and communication should mean we ultimately do what works in each person’s individual situation. I do not think we should fall into this trap of assuming only two positions because considering treatment options for individuals should not be mutually exclusive. I think everyone’s physiology is different and the medications they may need will vary. If practitioners are embracing pro-recovery principles they would be consulting with their patients about what works for them and respecting their choice to take a particular medication. I will be the first to acknowledge that I do not understand the human body’s chemistry to the extent that a psychiatrist does, but over the years I have worked with enough individuals taking psychotropic medications to understand that psychiatry should not be undertaken with a cookie-cutter approach.
ReplyDeleteHello Dustin, it is essential to be with the person and in collaboration with the person at the heart and in the lead of any treatment plan. We seem to all be focused on being present and actively listening to move forward as partner in recovery. It is so important to look at all the tools available and not get over-committed to one approach or cookie-cutter.
ReplyDeleteI do not believe the pro-recovery principles qualify as being anti-psychiatry. One does not have to completely choose one mode over the other, and it is dangerous and irresponsible to believe with absolute confidence that there is only 1 “right” path when it comes to providing treatment for clients. Being pro-recovery means being pro-client on all levels; it means being pro-treatment that supports overall health, wellness, and happiness of the client. This may mean avoiding more medically and psychiatrically based treatment methods, but it also may mean using more medically and psychiatrically based treatment. As an educator and school counselor I like to remind myself that every student is different - one method that works to engage one student may not work to engage another. The only norm that can be applied to all students is that they are most engaged when allowed choice as part of their learning. This works the same when applying to mental health – there is not one method of treatment that works for all clients. Rather paths to treatment must be individualized and are most successful when the client is allowed choice in treatment method. And a client may find that certain types of medication are helpful to them and they may choose to include medication in their treatment plan. Others, however, may find that medication hinders their path to treatment and it is simply important that mental health workers offer options and information and support as clients navigate these important decisions. Of course the challenge of this lies in those situations in which a person seems to be beyond rational thought; how does a mental health worker best support client choice when they worry that the client is unable of making appropriate, healthy decisions regarding their treatment? In these moments, it is important to reach out to fellow professionals as much as possible to collaborate and gain more knowledge regarding best practice. And it is still important to listen to the client and provide a space in which they feel safe and comfortable; even if he/she appears to be “out of their mind” with pain or anger or other states, any behavior that they exhibit is still a form of communication and is valuable information for treatment that supports the clients desires, needs, and path toward health, wellness, and happiness.
ReplyDelete