Mad in America: Rethinking Mental Health

Nikolas Rose is a professor of Sociology in the Department of Global Health and Social Medicine at King's College London. His work explores how concepts in psychiatry and neuroscience transform how we think about ourselves and govern our societies. Initially training as a biologist, Rose found his subjects unruly: "My pigeons would not peck their keys, and my rats would not run their mazes. They preferred to starve to death." He moved on to study psychology and sociology and has become one of the most influential figures in the social sciences as well as a formidable critic of mainstream psychiatric practice. A prolific writer, Rose has over fifteen books to his name, including, most recently, Neuro with Joelle Abi-Rached (2013) and Our Psychiatric Future (2018), addressing the most pressing controversies in the fields of neuroscience and psychiatry. He is also a former Managing Editor of Economy and Society and Joint Editor-in-Chief of the interdisciplinary journal, BioSocieties. Throughout his work, Rose emphasizes that one must look beyond origins, or "why something happened," and focus instead on the conditions under which ideas and practices emerge. The answers may not be comforting or straightforward, but they can help us to avoid band-aid solutions to complex problems. Rose builds on the work of philosopher Michel Foucault to reveal how concepts in psychiatry and psychology go beyond explanation to construct and construe how we experience ourselves and our world. Consistent with Foucault's oft-quoted adage, "My point is not that everything is bad, but that everything is dangerous," Rose's work avoids simplistic explanations of why and how the mental health fields go awry and instead examines how injustices can happen without unjust people. In this way, his work often transcends critique and imagines new possibilities and ways of thinking about "mental health," "normality," "brains and minds," and, ultimately, the selves we might yet become.

Jussi Valtonen is both a novelist and a psychologist. As a novelist, his work has been compared to both George Orwell's 1984 and Aldous Huxley's Brave New World for the way it weaves together social commentary and science fiction to jolt readers into confronting difficult questions about the soon-to-come worlds we are creating in the present. His research as a psychologist investigates how changes to the human brain impact how we think, experience, and make sense of the world. This includes recent investigations of the role of psychiatric drugs and polypharmacy on cognitive decline and functional impairment. Valtonen is from Helsinki and studied English, philosophy, and psychology in Finland before coming to the US to study neuropsychology at Johns Hopkins University and NYU.  He was also trained in screenwriting at the University of Salford in the UK and has worked as a journalist and science reporter. He has written three novels and a short story collection. Carried by Wings (2007) was given second place in Bonnier's novel competition, and received a warm reception from both critics and bloggers. Valtonen's recent book, They Know Not What They Do (2014), won the Finlandia Prize, Finland's highest literary honor. In this interview, Valtonen discusses how he found psychological science and literature to complement one another, the blind-spots in current psychiatric practice that harm patients, and how novels can help us to ask questions about the world we're creating.

This episode of the “Mad in the Family” podcast discusses the role of human interaction in child development. Specifically, how conflict and miscommunication between parent and child is not only O.K., but crucial to a young person’s social and emotional development. According to our guest, Dr. Claudia Gold, the “messiness” of our relationships is exactly what helps us build trust, resilience, and a solid sense of self in the world. That is the subject of her latest book, which she discusses with us. Claudia Gold, M.D., is a pediatrician, infant-parent mental health specialist, author, teacher, and speaker based in western Massachusetts. Dr. Gold practiced general and behavioral pediatrics for more than 25 years, focusing on a preventative model, and now specializes in early childhood mental health. She’s also the director of The Hello It’s Me Project, a rural community-based program designed to promote healthy relationships between infants and their caregivers. In addition, she works as a clinician with FIRST Steps Together, a federally funded program for pregnant and parenting women with opioid-use disorders, and as an infant-parent mental health consultant at Volunteers in Medicine, Berkshires. Dr. Gold serves on the faculty of the Infant-Parent Mental Health Fellowship Program at the University of Massachusetts—Boston, the Brazelton Institute at Boston Children’s Hospital, and the Berkshire Psychoanalytic Institute. She is the author of four books on child psychology and development: Keeping Your Child in Mind, The Silenced Child, The Developmental Science of Early Childhood, and most recently, The Power of Discord, written with Dr. Ed Tronick and published in June 2020. Claudia is the author of numerous articles, including Mad in America blogs, presents regularly for audiences of both parents and professionals around the world.

Ian Tucker is a professor and director of impact and innovation in the school of psychology at the University of East London. His expertise is in digital media, emotion, and mental health, he has published over 45 articles and book chapters and has a monograph book entitled Social Psychology of Emotion. He is currently authoring an Emotion in the Digital Age monograph for Routledge's Studies in Science, Technology, and Society series while working on several projects involving technology and mental health.  In this interview, we discuss how Ian became interested in studying relationships between technology, emotion, and mental health. He addresses some limitations of traditional psychological approaches to these topics and overviews some of his main areas of concern with how digital technology is being used to track people’s emotions and regulate their mental health. Drawing on philosophers like Gilbert Simondon and Henri Bergson, Ian also explores how digital technologies are being used within peer-to-peer communities to create information archives about experiences with distress and medication in ways that offer collective support. 

For our second interview for this World Benzodiazepine Awareness Day podcast I'm so pleased to get the chance to chat with Baylissa Frederick. Baylissa is a psychotherapist, coach, and author with two decades of experience working with people from all over the world. She holds a Master's degree in therapeutic counseling and is involved in helping people affected by prescribed antidepressants tranquilizer and opiate physical dependence and withdrawal. Baylissa is the author of the internationally successful self-help book Recovery and Renewal, the memoir With Hope in my Heart and two journals; Dearest Me and Dearest Friend. Baylissa herself was prescribed the benzodiazepine clonazepam, also known as Klonopin, for a form of dystonia, an involuntary movement disorder and she survived an intense withdrawal experience when coming off. She is now fully recovered and dedicates her time to helping and supporting others.

This week on MIA Radio, we present the second part of our podcast to join in the events for World Benzodiazepine Awareness Day 2020 (W-BAD). In part one, we interviewed Angela Peacock and talked about her experiences of taking and coming off benzodiazepines and also her involvement in the film Medicating Normal, which has a special screening and panel discussion on July the 11th at 1:00 PM EST. And before we go on, I just wanted to say that these podcasts would not be possible without the efforts of W-BAD lead operations volunteer Nicole Lamberson, who goes above and beyond to make these interviews possible. Later in this episode, we will hear from Baylissa Frederick, who is a therapeutic coach and psychotherapist with over two decades' experience working with clients affected by prescribed drug injury. But before we chat with Baylissa, I'm delighted to get the chance to talk with clinical pharmacologist Dr. Jim Wright. Jim is Emeritus Professor in the Departments of Anesthesiology, Pharmacology, and Therapeutics in Medicine at the University of British Columbia. Jim obtained his MD from the University of Alberta in 1968, and his PhD in pharmacology from McGill University in 1976. He is a practicing specialist in internal medicine and clinical pharmacology. He is also Editor in Chief of the Therapeutics Letter and he sits on the editorial boards of PLoS One and the Cochrane Library. Dr. Wright’s research focuses on issues relating to the appropriate use of prescription drugs, clinical pharmacology, clinical trials, systematic review, meta-analysis, and knowledge translation.

This week on MIA Radio we present a special episode of the podcast in advance of the events being held to mark World Benzodiazepine Awareness Day, July 11, 2020. The reason we are sharing this interview early is to help draw attention to a special screening of the film Medicating Normal which will be shown on World Benzodiazepine Awareness Day itself. Following this special screening of the film, there will be an online panel discussion featuring people with lived experience of taking and coming off benzodiazepines. If you haven’t yet seen the film, this screening is not to be missed. The film will be shown at 1 pm EST on July 11 and you can get tickets here. The film is presented by the Benzodiazepine Information Coalition, a non-profit organization that strives to educate about the potential adverse effects of benzodiazepines taken as prescribed and the Periscope Foundation which is a non-profit organization that funded the making and continues the outreach of Medicating Normal. For our interview this week I am delighted to get the chance to chat with Angela Peacock who appears in the film and will be a panel member for the online discussion. Angie served in the US Army from 1998-2004 and was medically retired after one tour in Iraq. She was medicated for post-traumatic stress since that time, going on and off benzodiazepines several times under a doctor’s care until coming off for the final time in January 2016. She holds a Bachelor of Science in psychology and graduated in May 2019 from Washington University in St. Louis- Brown School of Social work with a Masters in social work. As a 2019 Veterans of Foreign Wars-Student Veterans of America, Legislative Policy Fellow, she is advocating for change in Benzo policy at the Department of Veterans Affairs. She is embarking on a community outreach effort to improve medication and health literacy among military veterans and their family members. Angie chats about her experiences of being prescribed benzodiazepines, her journey off multiple medications, her continuing work in veterans advocacy and her thoughts about the film Medicating Normal. Medicating Normal special screening and panel discussion World Benzodiazepine Awareness Day Benzodiazepine Information Coalition Three Suicides: Honoring Lives Lost to Benzodiazepines The Many Battles of a Benzo Injury: Jean’s Story

Awais Aftab, a psychiatrist in Cleveland and Clinical Assistant Professor at Case Western Reserve University, explores the dynamic intersection of philosophy and psychiatry. He shares insights from his journey and emphasizes the significance of 'conceptual competence' in transforming mental health care. Aftab discusses disparities in psychiatric practices between Pakistan and the US, and how critical psychiatry challenges established views, particularly regarding psychotropic medications. His interview series promotes constructive dialogues, encouraging a respectful, nuanced approach to treatment.

This week on MIA Radio we turn our attention to electroconvulsive therapy (known as electroshock in the US). It’s fair to say that ECT remains a controversial subject with proponents and detractors regularly disagreeing on its safety and efficacy. The number of psychiatrists willing to administer ECT, particularly in the UK, is in decline but we are still using it to administer electric shocks to the brains of an estimated 2,000 people each year. In this interview, we discuss a recent paper from the journal Ethical Human Psychology and Psychiatry. The title is ‘Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses’ and it is written by John Read, Irving Kirsch and Laura McGrath. On MIA we have previously written about the study and its findings. We hear from two of the authors, Professor of Psychology John Read from the University of East London and Professor of Psychology Irving Kirsch from Harvard Medical School. We discuss: That the work aimed to review the quality of meta-analyses and any relevant clinical studies of ECT. How there have only ever been 11 studies that have compared ECT with sham ECT (SECT). Sham ECT is when the anaesthetic is administered but not followed by shocks to the brain. That in addition to reviewing the quality of the studies, the paper went on to consider the effect of placebo in the administration of ECT. That when reviewing the quality of studies, a 24-point scale was used and that the scorers were blinded to each other’s ratings. The 24-point scale included 5 basic Cochrane Collaboration criteria and an additional 19 quality indicators, some of which were specific to ECT procedures. The average quality score across all the studies was 12.3 out of a 24 maximum. One of the most important findings was that none of the studies reviewed were double-blind. The reason for this is that the patients can’t be blinded to the procedure because the adverse after-effects are very obvious. In reviewing the studies it was sometimes the case that only the treating psychiatrist was rating the effectiveness of the procedure, not the patient. The 5 meta-analyses themselves only contained between 1 and 7 of the eleven available studies. The recommendation from the paper is that the use of ECT should be suspended pending a properly controlled, rigorous clinical trial. That the UK’s National Institute for Health and Clinical Excellence (NICE) has decided to review their ECT recommendations in their depression guidelines, considering the review. That the Royal College of Psychiatrists has indicated that they will update their ECT position statement in light of the review. It has come to light recently that NHS Trusts in the UK are sometimes using out of date or incorrect information in their ECT guidance leaflets, an example of this is referring to ECT correcting a ‘chemical imbalance in the brain’. How the expectations of the treating doctor can influence the condition of the person undergoing the treatment. That the placebo effect can be large and long-lasting and that the more invasive the procedure, the larger the effect. That one of the characteristics of depression is the feeling of hopelessness and that when you are given a new treatment, it can instil a sense of hope which counters the hopelessness. That the call to prohibit ECT is because the negative effects of ECT are so strong, the fact that the evidence supporting it is so weak (especially in the long-term and beyond the improvement due to placebo) and that there are other means of addressing the difficulties that the person is dealing with. That placebos are, in essence, a type of psychological therapy. Links and further reading: Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses Richard P. Bentall: ECT is a classic failure of evidence-based medicine NICE guidance on the use of electroconvulsive therapy

Scott Greenspan recently received his doctorate in School Psychology from the University of Massachusetts Amherst. As a mental health counselor, he works to create opportunities for schools to be "hubs of wellness interventions." Scott's research draws from his own experiences working with youth in a variety of capacities, as well as his understanding of the vital role exercise plays in wellness. His research has focused on the integration of physical activity within school-based mental health programs as well as gender-affirming school-based interventions for sexual minority and gender diverse youth. Scott is currently completing his pre-doctoral clinical internship at Judge Baker Children's Center in Boston and holds an appointment as a Clinical Fellow at Harvard Medical School. In this interview, Scott discusses how a social justice approach informs his work and why it matters for schools to focus on gender diverse youth in sport. He addresses the influence that the COVID-19 pandemic may be having on adolescents and what parents and teachers can do to help. Scott offers practical solutions for integrating physical exercise into virtual learning. You can find out more about Scott on Linkedin and Twitter.