Mad in America: Rethinking Mental Health

This week on MIA Radio we turn our attention to psychiatric drug withdrawal and in particular the work of the International Institute for Psychiatric Drug Withdrawal. The Institute recently held a network meeting in Gothenburg, Sweden, where 40 leading experts from around the world came together to discuss the issues of dependence, withdrawal and iatrogenic harm relating to psychiatric drugs. The meeting participants included both professionals and those with lived experience. We chat with IIPDW founder Carina Håkansson and IIPDW Board Member Professor John Read. Following the meeting, the IIPDW released the following Press Release. INTERNATIONAL EXPERTS CALL FOR SERVICES TO SUPPORT MILLIONS TRYING TO COME OFF PSYCHIATRIC DRUGS Millions of people around the world are currently trying to come off psychiatric drugs but finding it extremely difficult because of withdrawal effects which are often severe and persistent, and because there is so little support available to come off the drugs slowly and safely. The 40 international experts attending this weekend’s meeting (end of September 2019) of the International Institute for Psychiatric Drug Withdrawal (www.iipdw.org) voted to endorse the  recommendations of the recent Public Health England [PHE] review of ‘Dependence and withdrawal associated with prescribed medicines’ and pledged to try to implement them in the 15 countries they are from, and beyond. These include: Enhancing clinical guidance and the likelihood it will be followed. Improving information for patients and carers on prescribed medicines, and increasing informed choice and shared decision-making between clinicians and patients. Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines. Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines. Participants agreed that besides antidepressants and benzodiazepines other psychoactive drugs, e.g. antipsychotics, should be included. They also agreed with PHE that ‘the goal is to make sure that our healthcare system builds awareness and enhanced decision-making for better patient treatment and support. These recommendations are just the beginning. All parts of the healthcare system and the general population will need to engage with this complex problem and work together to find solutions’. The meeting decided to hold a large international conference in Iceland in 2020. The meeting organiser, Dr Carina Håkansson (Psychotherapist, Sweden), commented: ‘All our hopes were exceeded. So many plans, local and international, emerged from this gathering of inspirational experts and activists. The time for change on this issue has clearly arrived’ carina@utvidgaderum.se Participants commented: ‘Psychiatric drugs destroyed 10 years of my life. I am so happy that we are finally addressing this issue of how to get off these drugs, which effects literally millions of people.’    Olga Runciman, Denmark (Psychologist, IIPDW Board Member) +45 27851003, orunciman@gmail.com   ‘Doctors should be able to prescribe the tapering medication strips I demonstrated at the meeting, which are required to stop safely. This is crucially important’. Dr Peter Groot, Netherlands (UMC University Hospital, Utrecht) +31 622290233  p.c.groot@ziggo.nl   ‘As an NHS Psychiatrist, I am aware how many lives are ruined by over-medication. We need to recognise that there are alternatives which are more powerful and less harmful.’ Dr Rex Haigh, UK (Berkshire) +44 7768 546983 rex.haigh@gmail.com   ‘The strong commitment all weekend, from researchers, clinicians and people with experience of psychiatric drugs was inspiring. The denying and minimizing of psychiatry and the drug companies will no longer prevail’. Professor John Read, UK (University of East London, IIPDW Board Member) +44 7944 853 783  john@uel.ac.uk   “I return to Brazil with a willingness to help the process of psychiatric reform in my country vigorously address the damage that the alliance between psychiatry and the pharmaceutical industry has done to our population.” Professor Fernando Freitas (FIOCRUZ, Member of IIPDW Faculty) + 55 21 2260 9200 ffreitas@ensp.fiocruz.br © Mad in America 2019

This week on MIA Radio, we chat with Professor Peter Kinderman. Peter is Professor of Clinical Psychology at the University of Liverpool, honorary Consultant Clinical Psychologist with Mersey Care NHS Trust and Clinical Advisor for Public Health England, UK. He was 2016-2017 President of the British Psychological Society (BPS) and twice chair of the BPS Division of Clinical Psychology. His research activity and clinical work concentrate on serious and enduring mental health problems, as well as on how psychological science can assist public policy in health and social care. His previous books include A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing, released in 2013. In this interview, we discuss Peter’s new book, A Manifesto for Mental Health, Why We Need a Revolution in Mental Health Care, which presents a radically new and distinctive outlook that critically examines the dominant ‘disease-model’ of mental health care. The book highlights persuasive evidence that our mental health and wellbeing depend largely on the society in which we live, on the things happen to us, and on how we learn to make sense of and respond to those events. Peter proposes a rejection of invalid diagnostic labels, practical help rather than medication, and a recognition that distress is usually an understandable human response to life’s challenges. We discuss: What led Peter to his interest in psychology, having initially been interested in physics and philosophy. How his academic and clinical work have influenced each other throughout his career. Why it is important to challenge mainstream mental health messages, not just as an academic exercise but also for the good of society. That it is pretty clear that we currently have a very poor system for responding to emotional distress. How we are not offering real-world help for real-world problems. That it is vital for us to offer people an alternative framework of understanding to allow them to decide for themselves how best to frame and therefore respond to difficulty. That Peter has observed changes in language that are helping to support public realisation that ‘mental illness’ is an idea or theory rather than undeniable fact. How a psychosocially-based mental health response might work. That Peter’s would like to see psychiatrists treating children to be employed by the authority also in charge of education provision. How our hierarchical health system gives doctors enormous power. That the Nordic countries have evolved a more socially-integrated and community-based approach, which better integrates health and social care. How those that are critical of the illness model are sometimes viewed as ‘deniers of real experiences’, but that this is a mischaracterisation because it is more about understanding those experiences in a different way or using a different framework. Relevant links: A Manifesto for Mental Health – Why We Need a Revolution in Mental Health Care A Prescription for Psychiatry – Why We Need a Whole New Approach to Mental Health and Wellbeing Professor Peter Kinderman, University of Liverpool, talks about a manifesto for mental health at the DECP Annual Conference 2016 Please support Mad in America - Donate now © Mad in America 2019

On MIA Radio, we interview Anthropologist Zhiying Ma, who explores mental health care in China, including tensions between Western psychiatry and socially-oriented local frameworks. Zhiying Ma is a cultural and medical anthropologist and disability studies scholar whose work explores the experiences and rights of those receiving mental health services in China. Her current book project, Intimate Institutions: Governance and Care Under the Mental Health Legal Reform in Contemporary China, investigates how the Chinese state has placed paternalistic responsibilities on families through their role in the care of those diagnosed with serious mental illnesses, in part through the practice of involuntary hospitalization. Ma came to earn a Ph.D. in Anthropology after questioning psychology’s overemphasis on decontextualized human behavior while majoring in the subject as an undergraduate. She found that anthropology offered the more humanistic and socially oriented lens she was looking for, and this perspective informs her current work. Ma collaborates with psychiatrists, social workers, human rights activists, lawmakers, families, and those with lived experience to not only conduct research but also to take part in China’s ongoing mental health policy discussions and push for community-based, socially inclusive care that is not simply “care as usual.” Please support Mad in America - Donate now

On MIA Radio this week, in the second of a number of podcasts focused on parenting issues, we interview Ben Furman MD. Ben is a Finnish psychiatrist, psychotherapist and internationally renowned teacher of the Solution-Focused approach to preventing and treating mental health problems in both children and adults. His numerous books have been translated into over 20 languages. Relevant Links Helping Children With Angry Outbursts The Kid Skills App Please donate If you are enjoying the Mad in America podcast, please consider  donating to help us continue to provide free content. Thank you. https://www.madinamerica.com/donate/ © Mad in America 2019

In our second week of MIA Veterans & Military Families, we interview U.S. Navy Veteran Dan Hurd. Dan is the Founder of Ride With Dan USAand the One Pedal at a Time Movement. After surviving his third suicide attempt, Dan became inspired to bicycle to all 48 States in the continental U.S. to help raise awareness about suicide. Along his journey, Dan has realized his attempts were likely caused by the medications he had been prescribed and now dedicates his life towards inspiring others to live life “One Pedal at a Time”.  (audio to be added) We discuss:  How Dan survived a rough childhood and came to be prescribed psychoactive medications as a teenager. That Dan found his time in the U.S. Navy to be the best time of his life. How he came to found Ride with Dan USAand the One Pedal at a Time Movement. Why he is biking all 48 states in the continental U.S., with a path that includes 25,000 miles and a three-year ride to raise awareness about suicide and to call for research. How all three of his suicide attempts were during periods of medication withdrawal. How his first attempt occurred in high school, six months before entering the U.S. Navy. How, a year after discharge from the Navy, Dan began getting prescribed medications again. Dan now realizes that meds were the likely cause of his suicide attempts. Life stressors were triggers, but medication withdrawal manufactured his risk. How Dan experienced severe physical pain as part of withdrawal from psychoactive medications, which was especially pronounced during the first year of his ride across the country. How his physical pain from withdrawal was so intense that it nearly ended his trip within the first six months of his journey. Dan talks about his concerns that psychoactive meds might have harmed his mother, and that her being prescribed these medications prior to his birth might have impacted his life today. How he hadn’t previously connected meds to his negative life events, specifically social isolation. Dan has gone from complete isolation while on meds to exploring all 48 states on his bicycle now that he is off of the drugs. How Dan has come to recognize medications aren’t solving a chemical imbalance, but instead are medicating symptoms, which led to polypharmacy. How Dan’s journey and sharing his story with others has helped him in his recovery and in finding balance in life. Dan’s Message to listeners: "Take life one step and one pedal at a time. If you’re experiencing challenges, tell everybody what is going on. Don’t expect help, because when you expect it, you’ll be disappointed. It’s when you’re asking for help and not expecting it, you’ll be happily surprised at what happens." Relevant Links: One Pedal at a Time Movement Ride with Dan USA Please support Mad in America - Donate now

Lillian Comas-Díaz is a pioneer in the field of ethnocultural approaches to mental health. She is both a clinical practitioner and multicultural feminist psychologist, writing numerous journal articles and books pushing the field toward more inclusive and less ethnocentric theories and practices. She was recently awarded the 2019 American Psychological Association gold medal awardfor lifetime achievement and the practice of psychology, the first time a person of color has been recognized with the award. She credits the long-term, collective effort of professionals of color working on expanding psychology’s lens to include the perspectives of marginalized peoples’ experiences. Comas-Díaz, along with her colleagues, recently introduced a special issue on the concept they call racial trauma (see MIA report). She describes racial trauma as “an insidious type of distress that many people of color and other marginalized individuals experience, where they are living in a society where racism, heterosexism, classism, and all those kinds of ‘isms’ are making the society oppressive towards those targeted groups.”

This week on MIA Radio we turn our attention to veterans, service members and military families. MIA has recently launched a new resource for military veterans which will provide news, personal stories and resources specific to veterans and their families. So to explain more about the new resources I am delighted to have been able to chat with Derek Blumke. Derek is the newest member of the MIA Team and he is the editor of the new veterans section. Derek served 12 years in the US Air Force and Michigan Air National Guard before attending the University of Michigan where he cofounded Student Veterans of America. For his work, Derek received the Presidential Volunteer Service Award and was recognised at the White House by President Barack Obama for his leadership in supporting returning military veterans. To listen and subscribe to the Mad in America podcast on Apple iTunes, click here. Listen also on Spotify, YouTube or Google Podcasts. We discuss: Derek’s time in the US Air Force and Michigan Air National Guard which saw him deployed to Afghanistan and Uzbekistan. How, following his service years, he transitioned to Community College in 2005 and then went on to the University of Michigan. How he came to feel that veterans were often isolated on campuses and this drove him to set up an organisation to provide support and connection for ex-service members, which became Student Veterans of America. That SVA is now the largest student organisation in the US and also the largest organisation of Iraq and Afghanistan veterans in the country. That during his three years running SVA, Derek became involved in legislative action to help send military service members to college (the Post-911 GI Bill). How veterans face unique challenges but shouldn’t be viewed as somehow broken or in need of specific support. That it was post-service experiences that led to Derek’s realisation that our approach to mental health could be leading to damage and harm. How Derek came to set up a tech company which he describes as ‘the most stressful and challenging time of his life’. That these stresses and strains led to being prescribed psychiatric drugs, initially Adderall but later having Ambien and Gabapentin added and eventually Zoloft too. How the side effects of this cocktail rendered Derek barely able to function and led to him moving back to Michigan. That he stopped socialising, stopped posting on social media and his social circle reduced because of the effects of the drugs. How these experiences led to questioning and some research and how he withdrew from five drugs over a month, with the most issues coming from the antidepressant Zoloft. His description of withdrawal effects including tinnitus, brain zaps, nausea, fatigue, anxiety and extreme dizziness. That he came to read the New York Times article: ‘Many people taking antidepressants find they cannot quit’ and realised he was in acute withdrawal. That it ultimately took Derek a year to come off the Zoloft. How he discovered Mad in America and realised that the messages in the mainstream mental health world do not do justice to the experiences that people are having with psychiatric drugs. How Derek got involved with MIA and came to lead our news veterans initiative. The suicide epidemic that has so severely affected the veterans community and how it results in more deaths than casualties from recent conflicts. That he hopes that the MIA veterans initiative will be seen as the equivalent of Yelp for veterans who want to read personal accounts and learn from unbiased and alternative sources. That Derek is starting a new non-profit: Walk There, which is designed to get people together to walk in their local area. Relevant Links: Mad in America Veterans Resources Student Veterans of America The Department of Veterans Affairs (VA) The New York Times: Many People Taking Antidepressants Discover They Cannot Quit Walk There

On MIA Radio this week, in the first of a number of podcasts focussed on parenting issues, we interview Dr. Craig Wiener, a licensed psychologist based in Worcester, Massachusetts, who specializes in the treatment of children, adolescents, and families. In addition to over 30 years of private practice, Dr. Wiener is an assistant professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. Dr. Wiener is the author of three books. most recently Parenting Your Child with ADHD: A No-Nonsense Guide for Nurturing Self-Reliance and Cooperation. Earlier this year he debuted his three-part video series “ADHD: A Return to Psychology,” which appears on the Mad in America website and also on YouTube. © Mad in America 2019

Pat Bracken is a psychiatrist who questions many of the fundamental assumptions of his field. He has worked as a psychiatrist in rural Ireland, inner-city and multi-ethnic parts of the UK, and in Uganda, East Africa. Bracken, who holds doctoral degrees in both medicine and philosophy, calls for a movement toward critical psychiatry. He was one of the people involved in starting the Critical Psychiatry Network, an organization of psychiatrists, researchers, and mental health professionals that question the assumptions that lie beneath psychiatric knowledge and practice. Through his clinical practice and his academic work in philosophy and ethics, he has seen the limits and dangers of standard approaches to mental health in the West. As a result, he has become an advocate for listening to different understandings of madness from those who are routinely ignored and dismissed — namely, service-users and people who themselves experience madness, and those from indigenous and non-Western cultures.

MIA’s Ayurdhi Dhar interviews Diana Kopua about the Mahi a Atua approach, the global mental health movement, and the importance of language and narratives in how we understand our world and ease our suffering. Diana Kopua’s life resembles the stories she uses in her work. From a psychiatric community nurse to the head of the department of psychiatry for Hauora Tairawhiti in Gisborne, New Zealand, her 13-year long, arduous journey is both deeply personal and profoundly political. Kopua says she did this to “become a wedge that kept the door open to allow for indigenous leaders” in her world to change the system. One may call her a storyteller, but a story-gatherer might be more appropriate. As a psychiatrist, Kopua deals in human distress but her interest does not lie in neat psychiatric classifications; instead, she focuses on understanding suffering through Maori creation stories, Purakau. She has developed Mahi a Atua, “an engagement, an assessment, and an intervention” to address the mental distress and suffering among the Maori of New Zealand. Mahi a Atua is not just a set of techniques or a culturally sensitive new therapy, but a drastically different way of conceptualizing the lived experience of the Maori. Recently, along with art and culture expert Mark Kopua and critical psychiatrist Pat Bracken, she published a paper on this approach in Transcultural Psychiatry. Their work can be seen as an alternative to Western pharmaco-therapeutic interventions currently being promoted throughout the global South via the global mental health movement. Researchers have critiqued the exporting of Western psychiatric practices, often citing the famous WHO study that reported better outcomes for people diagnosed with mental disorders in the developing world. As the only Ngati Porou (a Maori nation) psychiatrist in the world, working with a population known for poor mental health outcomes, Kopua’s work offers insight into what can be learned from local, Indigenous, and traditional healing methods. There are many now calling for a “paradigm shift” in Western psychiatry, and in our interview, we covered topics ranging from the specifics of the Mahi a Atua approach, the global mental health movement, and the importance of language and narratives in how we understand our world and ease our suffering. © Mad in America 2019