Mad in America: Rethinking Mental Health

Dainius Pūras is a medical doctor and human rights advocate. He is currently serving the final year of his term as the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health. He is also a professor at Vilnius University, Lithuania, and the director of the Human Rights Monitoring Institute, an NGO based in Vilnius. Pūras has been a human rights activist for 30 years involved in national, regional, and global activities that promote human rights-based policies and services, with a focus on mental health, child health, disabilities, and the prevention of violence and coercion. He was a member of the UN Committee on the Rights of the Child from 2007 to 2011. From the time he was appointed to the United Nations Human Rights Council in 2014, Pūras has pushed for a paradigm shift in mental health care. During his mandate, he has written several reports that emphasize the importance of the social determinants of health and criticize the dominance of the biomedical model and the medicalization of depression. While his work has occasionally been met with derision from some mainstream psychiatric institutions, he continues to bring attention to coercive practices and human rights violations and to call for greater investment in rights-based approaches to mental health care and suicide prevention. In this interview, Pūras discusses his own journey as a psychiatrist, his decision to get involved in human rights work, his goals for his UN reports, and the future of rights-based mental health care.

Sunil Bhatia is a professor and chair of the Department of Human Development at Connecticut College. He is the author of two books and over 50 articles and book chapters. He has received numerous awards for his work in the field of decolonizing psychology, cultural psychology, and qualitative methods and for studies of migrant and racial identities. Most recently, his second book, Decolonizing psychology: Globalization, social justice, and Indian youth identities,received the 2018 William James book award from the American Psychological Association APA). The movement to decolonize psychology is led by interdisciplinary scholars demanding a move away from the biomedical model of mental health and its colonial roots, especially in the Global South. Bhatia has been writing about these issues for over two decades and has often encountered resistance for speaking against mainstream voices. He is now one of the foremost experts in the field of decolonial studies. His work asks vital questions: Who decides what psychology should study? How do economic and social systems influence psychology? Is it possible to address economic inequality and social issues in psychotherapy? Does psychology speak of people, about people, or does it try to speak for them?  

This week on MIA Radio, we interview Nicole Beurkens, PhD, about the impact of the COVID-19 crisis and “quarantine life” on children with different types of behavioral, emotional, and neurodevelopmental challenges. Families may be understandably worried that the stress of lockdown may aggravate their child’s struggles. Yet, we hear some parents say the situation has changed their child for the better. Why might that be? A unique combination of psychologist, nutritionist, and special educator, Dr. Nicole Beurkens has over 20 years of experience supporting children, young adults, and families.  She is an expert in evaluating and treating a wide range of learning, mood, and behavior challenges. Dr. Beurkens holds a doctorate in clinical psychology, master’s degrees in special education and nutrition, and is a Board-Certified Nutrition Specialist.  She is the founder and director of Horizons Developmental Resource Center in Grand Rapids, Michigan, where she leads a multidisciplinary team dedicated to exceptional evaluation and integrative treatment services, research on innovative treatment protocols, and professional training on best practices. Dr. Beurkens is a highly sought-after international consultant and speaker, award-winning therapist, published researcher, and best-selling author.  Her work has been highlighted in numerous publications, and she is an expert media source.  When she isn’t working, Dr. Beurkens enjoys spending time with her husband and four children. (audio to be added) We discuss: Her background as a holistic therapist helping children with severe behavioral and emotional problems, which combines training and experience in special education, psychology, and nutrition. She integrates these skills to uncover and address the physical, social, and/or environmental “root causes” underlying her patients’ symptoms, which often include dietary, sleep, immune, and other previously undiagnosed issues. How “sheltering in place” slows down and simplifies life, which can benefit kids with neurodevelopmental, mental health and other challenges by reducing the usual heavy demands of school, therapies, and activities; allowing them to take the time they need to accomplish things; and letting them get more sleep. That schools tend to focus on academic achievement at the expense of developing other important skills such as planning, time management, and interpersonal relations. Being home offers parents an opportunity to focus on nurturing these life skills through planned and spontaneous family activities. How parents can leverage the plusses of staying at home and minimize the minuses. Lowering stress levels and activity overload is key: Parents should not only limit their expectations of their kids, but of themselves. That said, this is an opportunity for adult-child collaboration on household chores and decision-making, especially with older kids. The importance of maintaining balance between learning activities, personal development, play, creative pursuits, and exercise or movement, tailored to your child’s and family’s needs. These need not be structured to be valuable; some kids learn best through self-directed activity. Boredom and doing nothing can also be valuable; parents should not feel compelled to entertain or teach their children all day long. Specific strategies to support children with different types of challenges during this quieter period. For example, those typically given an ADHD diagnosis, whatever the underlying cause, struggle with planning, organizing, and follow-through. Now we can help them practice these skills and become more independent by developing their own goals and schedules for the things they want and need to do. The opportunities the pandemic offers children with anxiety to face their fears and “build resilience.” These include developing coping strategies with a parent or tele-therapist, such as practicing talking back to negative, scary thoughts, or inventing their own. It’s also important for parents not to dwell on dangers and worries in front of frightened kids and to limit kids’ exposure to the news media. How Dr. Beurkens is balancing her own personal and professional lives, including doing telehealth sessions while having all four kids and her husband around the house. She emphasizes that constant communication and renegotiating priorities are key, and advocates finding a daily structure that works for your job and your The importance of parents’ own self-care, including finding new ways to exercise and relax so you can be your best for your family. The need to “focus on what we can do rather than what we can’t.” Relevant Links Nicole Beurkens’s website

This week on MIA Radio we share the audio from our first Town Hall panel discussion. Mad in America, Open Excellence and the HOPEnDialogue project have collaborated to create an ongoing series of Town Hall discussions exploring the challenges, learnings and opportunities for personal and societal growth found through dialogical responses to crisis in the age of COVID-19. The title of this first discussion is: Are We Living in the Most Dialogical Time Ever? And the hosts are Kermit Cole and Louisa Putnam. COVID-19 has forced us all into new ways of being, new ways of relating to each other, and new ways of responding to each other in a time of crisis. These new ways reveal more clearly than ever how essential dialogue is to the human experience.  What are dialogical practitioners doing — and learning — in this time of crisis? What do these learnings suggest or make possible that might have previously seemed unattainable? What insights do people who have lived with a sense of crisis, often cut off from “mainstream” dialogues, have to offer a world in crisis? Hosts Kermit Cole and Louisa Putnam are inspired by Open Dialogue to respond as a team to individuals, couples and families in crisis. They have hosted many symposia in Santa Fe, New Mexico to explore the intersections between Open Dialogue, Hearing Voices, and other Dialogical approaches, and recently completed their studies under Jaakko Seikkula to be Open Dialogue trainers. Panellists Jaakko Seikkula teaches Dialogical practice to the many people around the world who have been inspired by the Open Dialogue, the response to mental health crises in Tornio, Finland that Jaakko’s team created. Richard Armitage is a dialogical practitioner and trainer in Denmark at a large centre for supported living and rehabilitation. Iseult Twamley is a Clinical Psychologist and Open Dialogue Trainer/Supervisor. Since 2012 she has been Clinical Lead of the Cork  Open Dialogue Implementation, Ireland.  Rai Waddingham is an Open Dialogue Practitioner, international trainer, and has created, established and managed innovative Hearing Voices Network projects in youth, prison, forensic, inpatient and community settings. Andrea Zwicknagl is a peer support worker in Switzerland and a board member of HOPEnDialogue.

This week on MIA Radio, we interview Sam Himelstein, PhD, about the impact of the Coronavirus crisis and “social distancing” policies on adolescents, taking a look at the unique needs teenagers and young adults may have and the challenges they may present for parents, caregivers, and other family members. Relevant Links Center for Adolescent Studies Family First Psychotherapy Sam Himelstein’s website

Ian Puppe is an instructor and research associate in anthropology at the University of Western Ontario in Ontario, Canada. Puppe’s work focuses on the anthropology of First Nations peoples, global studies, social justice, and peace studies. As an instructor at the university, he teaches anthropology of tourism and Indigenous Studies. He also currently serves as the Canadian Anthropology Society’s (CASCA) archivist, assistant editor/research associate with the Franz Boas Papers: Documentary Edition and Co-Principal Investigator/Research Lead for the Sioux Lookout Zone Hospital Archives Project (SLZHAP). Puppe has done ethnographic work on Algonquin Provincial Park in Ontario, and his research and writing investigate the relations between First Nation peoples and Canadian settler-colonial society. In this interview, he explores how Western approaches to mental health impacts Indigenous peoples, and how the imposition of psychiatric treatments can lead to harmful, unintended iatrogenic effects. *** Please Support Us: Our work is made possible by the generous support of our readers. To make a donation please visit this page. Thank you. https://www.madinamerica.com/donate/

Mab Segrest is Professor Emeritus of Gender and Women's Studies at Connecticut College and the author of Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum, and Memoir of a Race Traitor, both from the New Press. A long time activist in social justice movements and a past fellow at the National Humanities Center, she lives in Durham, North Carolina. Please Support Us: Our work is made possible by the generous support of our readers. To make a donation please visit this page. Thank you. https://www.madinamerica.com/donate/

This week on MIA Radio, we chat with Paula J. Caplan. Paula is a clinical and research psychologist, author of books and plays, playwright, actor, director, and activist. She was born and raised in Springfield, Missouri, attended Greenwood Laboratory School, received her A.B. with honors from Radcliffe College of Harvard University, and received her M.A. and Ph.D. in psychology from Duke University. Currently, she is an Associate at the Du Bois Institute, Hutchins Center for African and African American Research, Harvard University. She has been a Fellow at the Women and Public Policy Program of the Kennedy School of Government at Harvard; a Lecturer in Harvard's Program on Women, Gender, and Sexuality in the Psychology Department. She is former Full Professor of Applied Psychology and Head of the Centre for Women's Studies in Education at the Ontario Institute for Studies in Education, and former Lecturer in Women's Studies and Assistant Professor of Psychiatry at the University of Toronto. Paula is also a passionate and steadfast advocate for service members, veterans and their families. She has written: When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans and has founded the Listen to a Veteran! Project. In this interview, we discuss Paula’s work to support service members, veterans and their families, and the role psychiatric drugs have played in harming these communities. We discuss: Paula’s experiences that drove her towards working in mental health and advocating for veterans, which came from her father’s service in World War II. This included combat in the Battle of the Bulge. After hearing her father’s story that had been recorded as part of a history project, she learned her father had been a forward observer, and as result learned he had been on the front lines of the war. This led to her realizing that most American’s don’t understand military service and the only way of doing this, is through hearing veterans’ stories. Prior to the invasion of Iraq, she became concerned about the care of service members of veterans and veterans upon their return from war, and more concerned of the “psychiatrization”, diagnosing and prescribing psychiatric drugs to veterans. To get started in her efforts, she began by listening to a veteran share his experiences with her. The veteran talked for three hours, and Paula just listened. The next day, he called her and thanked her for listening, as he got a good night sleep for the first time in years. This led to her starting Listen to a Veteran, which was originally called “When Johnny and Jane Come Marching Home”. As part of this initiative, a veteran of any era can meet with another person who has volunteered to listen to the veteran share any stories or experiences they’re interested in sharing. Paula has faced barriers in getting this program expanded to the VA or throughout the “mainstream” mental health community because the system has been created to function based upon current “evidenced-based” best practices. How Paula is positive that we are currently causing harm to veterans and that alternative approaches need to immediately be implemented throughout the Department of Defense and Department of Veterans Affairs. How “therapy” needs to be dropped from the terms “art therapy”, “music therapy” and the like, so we can stop pathologizing individual experiences, and instead support people in doing things that improve their overall well-being. Any veterans who want to be a listener as part of Paula’s Listen to a Veteran initiative, or would like to have someone listen to them, they can go to listentoaveterans.org.

Welcome to MIA Reports, showcasing our independent and original journalism devoted to rethinking psychiatry. We take selected MIA Reports and provide them as audio articles. Click here for the text version of this and all of our MIA reports. Medication-Free Treatment in Norway - A Private Hospital Takes Center Stage Written by Robert Whitaker, read by James Moore with thanks to Birgit Valla for pronunciation assistance, first published on Mad in America, December 8, 2019. The Hurdalsjøen Recovery Center, which is a private psychiatric hospital located about forty minutes north of Oslo, on the banks of stunning Lake Hurdal, was set up by its director, Ole Andreas Underland, to provide “medication-free” care for those who wanted such treatment or who wanted to taper from their psychiatric drugs. Norway’s health minister was urging public mental hospitals to offer such treatment, and this private hospital stepped forward before any public hospital had taken the plunge. Hurdalsjøen opened on April 1, 2015. The first person to show up at its doors was 31-year-old Tonje Finsås, and she had a medical history that could fill volumes. She had developed an eating disorder when she was eight; she was put on antidepressants at age 11, which is when she started cutting herself; then came a prescription for a benzodiazepine; and soon she was cycling in and out of psychiatric wards with astonishing frequency. She arrived at Hurdalsjøen with prescriptions for 31 medicines, including three antipsychotics, and a record of 220 hospitalizations. She had spent most of the three previous years in isolation at a psychiatric hospital in Bergen, where she was watched over by two aides at all times, and was often restrained in a belt. “I tried to kill myself every day,” she recalled. “I didn’t want to live anymore. This was not a life. Even a dog in a cage has it better than what you have in there.” Although Lake Hurdal provides a beautiful setting, the hospital is located in a 1970s building, one that was used to treat people suffering from nervous problems, and inside it has an institutional feeling: small rooms located off a long hallway, not all that different from what you might find in an older psychiatric hospital. When Finsås balked at staying there, Underland proposed a novel solution.

Ian Parker is one of the most important contemporary critics of the discipline of psychology. A prolific writer, with over 25 books to his name, he has a formidable reputation in the fields of critical psychology, Marxist psychology, and psychoanalytic theory. He is a fellow of the British psychological society, Emeritus Professor at the University of Leicester, and the managing editor of the Annual Review of Critical Psychology. Parker is also a practicing psychoanalyst analyst and a member of the Centre for Freudian Analysis and Research and the London Society of the New Lacanian School. His career reflects the principles he talks about – the importance of challenging powerful institutions and the need for collectively mobilizing against discrimination and exploitation. As the "Psy-disciplines" face increased scrutiny for involvement in past abuses, continued collusion with powerful and unjust institutions, and deep criticisms over current psychological research and practice, Parker's work has particular relevance. His criticisms of psychology and psychiatry started from his university days as a student. He observed that while other social sciences were critical of their received knowledge and open to contributions from the civil rights and women's movements, psychology continued to reinforce old power relations and pathologized these same social movements. Since then, Parker has become one of the most well-known critics of mainstream psychology, and his work repeatedly questions the role of ideology and power in the field. These contributions are evident throughout his writing, including his four-volume 'major work' Critical Psychology (2011) and a Handbook of Critical Psychology (2015). He is currently the editor of the 'Concepts for Critical Psychology' series for Routledge.