Mad in America: Rethinking Mental Health

Michael Ungar is the founder and director of the Resilience Research Centre at Dalhousie University in Canada. He is also a family therapist and professor of social work. He has received numerous awards, such as the Canadian Association of Social Workers National Distinguished Service Award (2012), and has authored around 15 books and over 200 peer-reviewed articles. Dr. Ungar's work is globally recognized and centers on community trauma and community resilience. In particular, his work explores resilience among marginalized children and families, especially those involved with child welfare and mental health services, refugees, and immigrant youth. His research is spread across continents and challenges our traditional notions of trauma and resilience. Analyzing people's risks and available resources, he scrutinizes simplistic ideas of individual perseverance and grit in the face of trauma. Instead, he implicates the role of context, circumstances, and ill-suited services in contributing to people's psychological suffering.

Patricia Rush, M.D., M.B.A. is an internal medicine physician whose scientific focus is complex chronic illness. Her over 40-year career has focused on working with underserved populations and promoting universal access to high-quality medical care. She spent 20 years in the Cook County (Illinois) Health System, including six years as director of their emergency department. From 2000-2008 ran a trauma-informed solo private medical practice in Chicago. During this time, she completed in-depth interviews with more than 500 patients, which led her to identify a group of high-risk individuals with serious illnesses who also had a consistent pattern of extreme stress at a young age, including profoundly disordered sleep and emotional distress. Until her retirement, Dr. Rush was also an Associate Professor of Medicine at the University of Chicago and now teaches neurodevelopment as a member of the Physician Workgroup of the Child Trauma Academy. She was a co-founder and serves as a co-director of the Center for the Collaborative Study of Trauma, Health Equity, and Neurobiology, or THEN, in Chicago. The nonprofit works at the intersection of science education and social justice, exploring and communicating the links between early emotional trauma, inequality, human development, and chronic illness to a network of professionals and the public. In this interview, she discusses a new and more integrated way to understand and treat physical and mental ailments in people of all ages that has important implications for how we raise our children.

Marcela Ot'alora works with the Multidisciplinary Association for Psychedelic Studies (MAPS) as the principal investigator for government research into MDMA-assisted psychotherapy. In addition to her role as principal investigator, she also worked as a co-therapist during earlier phases of MDMA psychotherapy research and currently leads the MDMA therapy training for MAPS. Ms. Ot'alora also works as a therapist using both ketamine and fine arts to treat trauma. Ot'alora approaches her work with a humility learned from years of therapeutic experience: "My clients and the participants in our studies have taught me that their healing looks so different than anything I could have imagined. If I come in leaving that agenda, leaving that bias aside, and being present with whoever is in front of me, they will surprise me every time about how healing works for them." In this interview, we discuss her research into MDMA-assisted psychotherapy and how the use of MDMA differs from more traditional substances such as antidepressants. We will also discuss ketamine-assisted therapy, the therapeutic use of fine arts, and the over-prescription of psychiatric drugs.

Michelle Funk is the Unit Head of the Policy, Law, and Human Rights at the Department of Mental Health and Substance Use at the World Health Organization. She has created and leads the WHO Quality Rights Initiative that aims to assess and improve human rights standards in existing services and advance the full implementation of the UN Convention on the Rights of Persons with Disabilities (CRPD). In this interview, we discuss the launch of the new "Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches." The document is grounded on the principles of recovery and rights-based approaches. It presents successful examples of best practices in mental health service provision respecting dignity, moving to zero coercion, and eliminating neglect and abuse. Among the best practices showcased in the document are Open Dialogue as practiced in Tornio, Finland, Soteria Berne in Switzerland, Afiya House in Western Massachusetts, Basal Exposure Therapy in Norway, and Hearing Voices Support Groups. The Guidance builds on the momentum created by the critical voice of Dainius Pūras, former UN Special Rapporteur on the Right to Health. Puras criticized the dominance of the biomedical model in the Mental Health field and highlighted the harms associated with ignoring the social determinants of health that impact a person's mental health, such as violence, poverty, lack of proper nutrition, housing instability, lack of universal health coverage, discrimination and others. In our conversation, Michelle Funk described the process of engaging stakeholders and persons with lived experience throughout the design and development of the document, the challenges of ensuring geographical representation given the global inequalities, and the hopes for the future.

Ilana Mountian is a researcher drawing on psychoanalytic, critical, decolonial, and feminist philosophies. She is the author of Cultural Ecstasies: Drugs, Gender, and the Social Imaginary, exploring discourses around drug use, gender, and drug policy. She is currently working on a book that will be published later this year by Routledge about otherness and mental health, focusing on immigration, drug use, and transsexuality. Mountian is a member of the Discourse Unit, a group led by well-known critical psychologists Erica Burman and Ian Parker. The Discourse Unit is dedicated to providing teaching resources for qualitative and feminist work, producing radical academic work, and developing critical perspectives in action research. In addition to her work as a researcher, Mountian is a psychoanalyst and a postdoctoral lecturer at the University of Sao Paulo Brazil and Manchester Metropolitan University. In this interview, she discusses intersectionality and drug use, the disease model of addiction, psychiatric labels, and psychiatry's place in creating "otherness."

This week on the MIA podcast we are providing the audio taken from our recent psychiatric drug withdrawal town hall held in May 2021. For our third discussion, we are examining protracted problems that can arise after psychiatric drug withdrawal. Sometimes referred to as post-acute or post-withdrawal syndromes, these experiences can include chronic health problems and sexual dysfunction. What do we know and not know about responding to long- term health problems after coming off psychiatric drugs? For references and slides mentioned in the discussion, visit this link: https://www.madinamerica.com/pdwref/ Panelists Adele Framer Adele Framer resides in San Francisco, USA. A survivor of 11 years of antidepressant withdrawal syndrome, in 2011, under the pseudonym Altostrata, she founded the peer support site SurvivingAntidepressants.org, currently containing more than 6,000 longitudinal case histories from its 14,000 members. A widely recognized patient advocate, she is a lay expert in psychiatric drug tapering and withdrawal syndromes. Will Hall Will Hall is a schizophrenia diagnosis survivor and longtime organizer with the psychiatric survivor movement. He is a PhD candidate at Maastricht University and lead researcher on the Maastricht World Survey on Antipsychotic Drug Withdrawal, and author of the Harm Reduction Guide to Coming Off Psychiatric Drugs, as well as host of Madness Radio and a co-founder of the Hearing Voices Network USA. David Healy David Healy is a Professor of Psychiatry in the Department of Family Medicine at McMaster University in Hamilton Canada. He has been raising concerns about withdrawal from antidepressants since the mid-1990s and was an expert witness in a successful legal case about withdrawal and dependence in 2004. He figures we have made little or no progress sorting the issues out and now have a major public health crisis on our hands. Nicole Lamberson Nicole Lamberson is a physician assistant as well as a patient suffering protracted harm following a rapid medical "detox" from prescribed benzodiazepines/Z-drugs & other psychotropic polypharmacy. She co- founded The Withdrawal Project, serves on the Medical Board of Benzodiazepine Information Coalition, & does outreach for Medicating Normal-The Film.

Hannah Pickard, a Bloomberg Distinguished Professor of Philosophy and Bioethics at Johns Hopkins University, dives into innovative perspectives on addiction and mental health. She introduces her 'Responsibility Without Blame' model, challenging traditional ideas of accountability. The discussion highlights the importance of therapeutic communities and personalized narratives in recovery, while critiquing the brain disease model of addiction. Pickard also emphasizes how cultural contexts shape experiences of addiction, advocating for a balanced understanding that considers both agency and social impacts.

Katrina Michelle is a psychologist and the founder and director of The Curious Spirit, a transpersonally oriented psychotherapeutic practice that encourages transcendent personal exploration to remedy psychological suffering. She is a holistic psychotherapist currently serving as faculty at Columbia University School of Social Work and The Institute for the Development of Human Arts. In addition to her practice, she also serves as the director of harm reduction for the Multidisciplinary Association for Psychedelic Studies (MAPS) and formerly worked as the executive director of the American Center for the Integration of Spiritually Transformative Experiences (ACISTE). To demystify awakening experiences through storytelling and art, she is also producing the film When Lightning Strikes. Beginning in the world of traditional social work, Michelle was drawn to transpersonal psychology after her own spontaneous spiritually transformative experience. She now works to help create communities capable of holding these often difficult experiences, as western societies often lack the language and cultural understanding needed to integrate them into daily life. In this interview, we discuss the place of psychedelics in psychotherapy, how spiritually transformative experiences can be mistaken for 'mental illness,' and the various resistances we have to these experiences.

Hannah Zeavin is a leading scholar investigating how mediated communications and technology impact our intimate relations. Her most recent work tackles teletherapy and digital mental health communications, which have seen a boon throughout the pandemic. Zeavin is a Lecturer in the Departments of English and History at the University of California, Berkeley, and affiliated with the Berkeley Center for Science, Technology, Medicine, and Society. Zeavin is also a visiting fellow at the Columbia University Center for the Study of Social Difference. She received her Ph.D. from the Department of Media, Culture, and Communication at NYU in 2018. Her first book, The Distance Cure: A History of Teletherapy, will be published by MIT Press this summer. Zeavin serves as an editorial associate and author for numerous publications, including the Journal of the American Psychoanalytic Association. She is also a co-founder of The Science, Technology, and Society Futures Initiative. In this interview, she discusses her upcoming books and all things mediated communication, teletherapy, and technology. Zeavin approaches human relationality, including therapy, from the perspectives of literature and media studies. She explores the history of psychoanalysis and other forms of therapy, garnering fresh insights into our relationship with technology and each other–without the usual moral tenor of psychologists. She also draws upon her research to discuss how care may take unexpected forms through technologies, enabling distanced intimacy and social change that transcends the psychology of the individual. We close by addressing the feminization of care labor, care as a cover for capture and control, and shifts in how we understand care, now and in the future.

*** Our next psychiatric drug withdrawal town hall discussion will be held on May 14 2021, register here: https://www.eventbrite.co.uk/e/150023595613 *** This week on the MIA podcast we are providing the audio taken from our recent psychiatric drug withdrawal town hall held in March 2021. This discussion was aired live on March 12, 2021 and the panelists are Dr Giovanni Fava, Dr Peter Groot, Dr Mark Horowitz and Professor Joanna Moncrieff. For this discussion, we asked what science and research can tell us about the experience of withdrawal. We discuss research effort that has called into question long-held professional beliefs about the effects of psychotropic drugs on the brain and nervous system. Panelists Giovanni Fava Dr Giovanni Fava is Clinical Professor of Psychiatry at the State University of New York at Buffalo. He has authored more than 500 scientific papers and performed groundbreaking research in several fields. He is editor-in-chief of the journal Psychotherapy and Psychosomatics. Peter Groot Dr Peter Groot is a researcher who started using antidepressants. His own experiences helped him to develop a practical solution proposed by many patients to help prevent withdrawal problems from antidepressants and other psychotropic drugs. Mark Horowitz Dr Mark Horowitz is a training psychiatrist and psychiatric academic at University College London who is currently coming off psychiatric drugs. His work and research focuses on how to safely stop psychiatric medication. Joanna Moncrieff Dr Joanna Moncrieff is a psychiatrist based in community mental health services in North East London. She also teaches and researches at University College London. Joanna is one of the founding members and the co-chairperson of the Critical Psychiatry Network.