Mad in America: Rethinking Mental Health

Science and Pseudoscience of Mental Health Podcast: Episode 3 This past week, I had the great pleasure to talk with Dr. Kelly Brogan, a leading voice in natural approaches to women’s mental health. Dr. Brogan began her career as a conventional psychiatrist, but following the birth of her first child, she felt bereft of energy and mental clarity and was diagnosed with an autoimmune condition called Hashimoto’s Thyroiditis. Informed by her doctor that she had a chronic illness that would require a lifetime of medication, she launched her own research into her condition which catalyzed a profound paradigm shift in her understanding of health and wellness. Her research led her to Robert Whitaker’s Anatomy of an Epidemic after which time she permanently retired her prescription pad while turning towards natural interventions that support the body’s innate capacity to heal. With degrees from MIT and Weil Cornell Medical College, triple board certification in psychiatry, psychosomatic medicine and integrative holistic medicine, and direct experience practicing within the parameters of conventional psychiatry, Dr. Brogan is uniquely qualified to challenge the pseudoscience of the chemical imbalance theory and the drug regimens that it spawned. At the same time, her rigorous education conferred the investigative tools that enabled her to identify the scientific principles that support mental health. She focuses on the integrative nature of the gastrointestinal, immune, endocrine and nervous systems and their seamless communication with the ecosystem that resides within the body – the microbiome – and the ecosystem that surrounds us. This science is at the core of her thirty-day wellness protocol which she outlines in her New York Times bestselling book: A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies and reclaim Their Lives. Our conversation addressed Dr. Brogan’s grave concerns about the recent rollout of Zulresso (brexanolone), a drug specifically designed, and approved by the FDA for the treatment of Postpartum Depression. Drug trials that qualified Zulresso for FDA approval in fact revealed that its efficacy is weak at best, and not clinically significant. After 30 days, it was actually less effective than placebo. It requires an invasive 60-hour IV infusion with side effects that include sedation – sometimes to the point of loss of consciousness, separation of mother and infant, and cessation of breastfeeding. Women diagnosed with Postpartum Depression are suffering, but impactful interventions need to take into account the complex cultural, socioeconomic, personal and biological underpinnings of their symptoms. Masking symptoms with a drug that causes further disruption to their lives, lessens the likelihood that they will receive effective support. Dr. Brogan estimates that 80% of women who enter her practice having been diagnosed with Postpartum Depression have undetected and untreated thyroid conditions. We also discussed the reckless prescribing of SSRI antidepressants to one in four American women, many of whom are pregnant, and the long-term epigenetic consequences of SSRIs following prenatal exposure. Dr. Brogan shared her approach to tapering from SSRIs both during pregnancy and as part of her general treatment protocol. Our conversation came to a close with a fascinating exploration of the science that informs the relationship between meditation and mental health. Dr. Brogan shared the transformative impact that her own daily meditation practice has had on her capacity to cope with stress. To learn more about Dr. Brogan’s clinical work and research, you can visit her website. For other interviews in this series, click here. © Mad in America

On MIA Radio this week, MIA's Zenobia Morrill interviews Dr. Vance Trudeau, a professor at the University of Ottawa in Canada. Dr. Trudeau describes a recent study he conducted, alongside a team of researchers, led by Dr. Marilyn Vera-Chang, that has implications for understanding of the long-term impact of antidepressant drug exposure (see MIA report). The study, titled Transgenerational hypocortisolism and behavioral disruption are induced by the antidepressant fluoxetine in male zebrafish Danio rerio linked antidepressant exposure to decreased coping behaviors in zebrafish that lasted several generations. Dr. Trudeau is the research chair in neuroendocrinology at the University of Ottawa, where he studies how the brain regulates hormonal activity in fish and frogs. Such analyses offer important insights into the effects of environmental exposures on human health because these hormonal systems are shared across species. © Mad in America 2019

This week on MIA Radio, we chat with Doctor Lee Coleman. Lee trained in psychiatry during the 1960s, quickly adopting a sceptical attitude to the newly emerging field of biological psychiatry and rejecting the idea that drugs could be beneficial for so-called ‘mental disorders’. By the early 1970s, Lee’s professional life was divided between a small home-based practice of psychotherapy and a variety of activities – writing, speaking and political advocacy – focused on psychiatry’s role in society. His experiences led to writing the book Reign of Error in 1984 in which he brings to bear his lengthy experience in both clinical and legal issues surrounding Psychiatry and Society. Now retired, Lee devotes his time to public education that exposes the individual and public harms from today’s “mental health” industry. He seeks to support a grassroots movement to abolish forced “treatment” and provide tools to amplify the voices of those seeking change. The discussion today marks the first in what will hopefully be a series of interviews on a range of topics which will be released on the podcast over the coming months. In this episode we discuss: What led Lee to his interest in attending medical school during the 1950s and his fascination with the burgeoning field of biology. How, once he got to medical school, he found he did not care for psychiatry’s biological orientation. The Lee’s residency period was 1965 to 1969 and this marked a period of decline of psychoanalysis and the rise of biomedical psychiatry. That Lee came to see himself as part of what was called at the time ‘community psychiatry’ which was socially oriented. How, in the late 1960s, psychiatry was feeling the heat from psychologists, social workers and even some religious counsellors who started lobbying to get licenses to provide therapy. How psychiatry then started going on the offensive to redefine itself as having the leading medical expertise in mental health. That Lee was extremely concerned to learn about the legal power of psychiatry and this was a motivator to write The Reign of Error in 1984. How a book called Soledad Brother: The Prison Letters of George Jackson called into question much of what Lee had been taught during his residency. That Reign of Error is about both what is wrong with psychiatry and the fact that it is linked to the power of the State. That Lee has participated in well over 800 legal cases as an expert witness, but he has never testified as to the state of a person’s mind, instead he has testified on the state of psychiatry. That Lee has testified to the fact that psychiatrists are generally worse at assessing someone’s mental state than the average lay-person in the jury. How language can falsely lead us to believe that science underpins the actions of psychiatrists, something Lee refers to as The War of the Words. That we have to fight back by explaining properly what words like ‘treatment’ actually mean. How American psychiatry is leading the way to the worldwide drugging of citizens and that we need political action to resist this future. Relevant Links: Doctor Lee Coleman The Reign of Error Lee’s YouTube Channel Soledad Brother: The Prison Letters of George Jackson © Mad in America 2019

Interview by Peter Simons. Dr. Mark Horowitz is a training psychiatrist and researcher and recently co-authored, with Dr. David Taylor, a review of antidepressant withdrawal that was published in Lancet Psychiatry, which we've written about here at Mad in America (see here). Their article suggests that tapering off antidepressants over months or even years is more successful at preventing withdrawal symptoms than a quick discontinuation of two to four weeks. Dr. Horowitz is currently completing his psychiatry training in Sydney, Australia, and has completed a PhD in the neurobiology of antidepressants at the Institute of Psychiatry at King's College, London. He is a clinical research fellow on the RADAR study run by University College, London. His research work focuses on pharmacologically informed ways of tapering patients off of medication. He plans to conduct studies examining the best methods for tapering medications in order to develop evidence based guidelines to assist patients and doctors.

This week, MIA Radio presents the fifth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team. We interview Dr. Gail Hornstein, a Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts. She is the author of To Redeem One Person is to Redeem the World: The Life of Frieda Fromm-Reichmann and, most recently, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. In her work, she chronicles both the personal narratives of people with lived experience of being treated as “mad,” and also the growing movement of survivor and service-user activism. Her Bibliography of First-Person Narratives of Madness in English (now in its 5th edition) lists more than 1,000 books by people who have written about madness from their own experience; it is used by researchers, clinicians, educators, and peer groups around the world. She is now director of a major research and training project investigating how hearing voices peer-support groups work, supported by a grant from the Foundation for Excellence in Mental Health Care. This project is training dozens of new hearing voices group facilitators across the US and sponsors research to identify the key mechanisms by which this approach works.

This week on MIA Radio, we turn our attention to Open Dialogue and we chat with psychotherapist and Open Dialogue trainer Alita Taylor. Alita is a licensed Marriage & Family Therapist, trainer and facilitator based in Tacoma, Washington USA. Her passion is working from a community-based, non-expert, need-adapted Open Dialogue perspective, which utilizes social networks, family, and co-facilitation with other professionals. In this recent blog, Alita shares why Open Dialogue ‘cannot be taught, but needs a teacher‘. Love Is In the Air… I am in love. I’m in love with this way of working. And I won’t stop. Open Dialogue Washington began in 2018 upon my graduation/commencement from Jaakko Seikkula’s dialogic approaches to couple and family therapy trainer/supervisor training, in collaboration with Dialogic Partners and the University of Jyväskylä. In 2016, I embarked to partake in the best training course I had ever experienced as a family therapist. The embodiment I experienced working with my Open Dialogue colleagues felt like the missing key in psychiatry and psychotherapy. Something intangible, yet what I knew all along. Something ineffable, yet also a shared language. Something deeply and autonomically human, yet unrepeatable and fleeting. It led me onto a moment-by-moment path where everything I learned in my 27-year long career about systemic family therapy and emergency psychiatric protocols ebbed, and the present moment of love flowed, neither the ebbing knowledge nor the cresting wisdom having any lesser value than the other.  The complete work we do in mental health care is this ocean of love. We are in constant change when we are in crisis. Timelessness sets in. Growth is happening.  We don’t exactly know what we need. That is what mental health work is, sitting with this human happening. In the in-between space, something happens, and we don’t know what will. This is the paradox. We are navigating the ebb and flow of incoming knowledge we have from research and the ebb and flow in each patient and family’s difficulties (the meanings they make of them). “It cannot be taught, but it needs a teacher.” After getting trained to facilitate and supervise Open Dialogue, I found that this is the crux of the work, holding more than one truth. As human beings, as a society, as mental health practitioners, we must be able to ask what is helpful, and we must be willing to co-provide this “help” creatively, without barriers, between the digitized rows and columns of tick-boxes and presumptive diagnostic menus.  Remember the analog world of dials and infinite decimals? Agency lies within ourselves to expand the possibilities, to be willing to open to solutions that have not yet been tried. Michael Pohl wrote about dialogical leadership and culture in which he referenced Karl-Martin Dietz and Thomas Kracht of the Hardenberg Institute for Cultural Studies in Heidelberg, Germany. Michael remembered a discussion on whether dialogism can be taught or experienced. It was argued that the dialogic attitude cannot be learned and that any thought of teaching it is unnecessary. Michael disagreed. He writes, “It cannot be taught, but it needs a teacher.”— Medium.com, March 2018. In Helsinki and Tornio while learning the Open Dialogue approach, I had many teachers: Jorma Ahonen, Pekka Borchers, Birgitta Alakare, Aino Maija Rautkallio, Kari Valtanen, Tom Erik Arnkil, Jaakko Seikkula, Tapio Salo, Tanja Pihlaja, Eija-Liisa Rautiainen, Pekka Holm.  How did they do it? To quote Birgitta Alakare when she was asked about the beginnings of the development of Open Dialogue in the 1980’s, “It was not only me, it was all of us, everyone.” When we include all the stakeholders, all the voices, polyphonically, something extraordinary is given space to emerge. This is challenging to enact when there are systems of health care based on bed occupancy, lengths of stay, productivity, staff ratios, definitions of “emergency” or “inpatient” levels of care. Well, Open Dialogue Washington is bringing to the fore the question, “What is our role as helpers??”  To quote Mia Kurtti, Open Dialogue trainer of Tornio, Finland, “What are we really doing here?” Caring for our mental health, however defined (crises, hard times, depression, psychosis), is a human need that varies from moment to moment. I learn from every client and family I sit with. In Open Dialogue, multiple perspectives are allowed, in fact invited. Unusual experiences are uncategorized mystery, and understanding between client and family/social network is continuously underway. The course of schizophrenia was reversed in Western Lapland, and their inhabitants trust their mental health system. Hmmm… if we want to save State and Federal dollars and our own livelihoods, perhaps we should allow ourselves to practice psychotherapy and psychiatry with more questions than answers. Perhaps the ones in crisis will teach us what we didn’t know. Love is somewhere, here, in the air. Relevant links: Open Dialogue Washington Open Dialogue Training, April 2019 Open Dialogue UK

This week on MIA Radio, we interview Professor Jim van Os. Professor van Os is Chairman of the Division of Neuroscience at Utrecht University Medical Centre, Utrecht, The Netherlands, and Visiting Professor of Psychiatric Epidemiology at King’s College, Institute of Psychiatry in London. He trained in Psychiatry in Casablanca, Bordeaux and the Institute of Psychiatry and the Maudsley Royal Hospital in London. We last spoke with Jim for the podcast in August 2017 and this time we focus on a recent paper written by Jim and co-authors that was published in the journal World Psychiatry in January 2019. The paper is entitled ‘The diagnosis evidence-based group-level symptom-reduction model as organizing principle for mental health care. Time for change?‘ In this episode we discuss: What the diagnosis evidence-based group-level symptom-reduction model is and how it currently informs mainstream mental healthcare. How mental health funding and mental health professional partners work together to monitor and assess the effects of current evidence-based interventions. How this curative medical model is attractive, but often fails to work for patients. That the focus on biological, brain-based diseases and symptoms conflicts with the experience of people who are attempting to develop a narrative view of their difficulties and suffering. That the paper is an attempt to start a discussion about building a synthesis between the diagnosis, symptom-based medical world and the lived experience of individual people. How the creation of specific and discrete diagnoses has reinforced the symptom-led approach to mental health and has also necessitated the stratification of doctors into silos of expertise. How Jim favors a spectrum-based approach over a fixed diagnosis and that an example is autism spectrum disorder as described in DSM V. The limitations of using ‘target symptom reduction’ as an outcome measure for mental health. That symptom reduction can be beneficial in the short-term but is not a good long-term measure of recovery. That the paper attempts to make clear how important individual experiences are and the need to be sensitive to the existential domain, saying “restoration of health is not the goal, it is the means to enable a person to find and pursue meaningful goals, accordingly, the person’s existential values become central”. That the evidence suggests that any treatment effect or improvement is often down to meaningful interaction rather than the specific expertise of the treating professional. That, in many countries, we still see a huge gulf between mental healthcare and social care which remain separate and remote from each other and that this separation is not how the person experiences their world. The importance of including lived experience in the evidence base, particularly because randomized controlled trials, considered the gold standard of evidence, are often not conclusive in the field of mental health. That, in mental health, evidence shows that 30% to 40% of the response is down to placebo and the expectation of being helped. That the desire is to make the existential domain the primary lens through which to view human experience and to respond to mental or emotional suffering. That, arguably, ‘love is the most powerful evidence-based treatment in mental health’. Relevant links: Professor Jim van Os The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change? Tedx: Maastricht, Connecting to Madness ISPS Liverpool Conference Jim Van Os Keynote Address Schizophrenia does not exist © Mad in America 2019

In this second interview in our Science and Pseudoscience of Mental Health series, Dr. Sharna Olfman interviews Dr. Darcia Narvaez.  In 1955, Erich Fromm published a book called The Sane Society. The basic premise is that cultures that support our existential needs for love, community, autonomy, creative expression, purpose, meaning, and communion with nature, enable us to become fully actualized, sane human, beings. Cultures that fail to do so, engender mental illness. Darcia Narvaez,1 a Professor of Psychology at the University of Notre Dame, has taken up the mantle of Fromm’s quest to identify and promote sane cultural practices that foster mental health. A prolific multidisciplinary scholar, her recent books include Neurobiology and the Development of Human Morality: Evolution, Culture and Wisdom (2014) and Basic Needs, Wellbeing and Morality: Fulfilling Human Potential (2018). To read more about Dr. Narvaez' work, visit this link: https://www.madinamerica.com/2018/12/reclaiming-humanity-dawn/ © Mad in America 2018

When we discuss the issue of forced treatment, coercive mental health interventions like involuntary commitment, forced drugging, and electroconvulsive therapy usually come to mind. But force and coercion can be much more subtle. Many researchers and thought leaders have argued that our society mandates us to be happy and perform well-being at all times through cultural norms, media depictions, and workplace and school regulations. This week on MIA Radio we interview Will Davies, Reader in Political Economy at Goldsmiths University of London, and author of The Happiness Industry, a book that explores the rapidly growing culture of mandated happiness and well-being surveillance. In this interview, we discuss the increasing pressure people face to be happy and think positive, and how this pressure serves the interests of the corporate elite and the State. In this episode we discuss: What the “happiness industry” is and the history of its development How the notion that happiness can be quantified or measured, as well as advancements in neuroscience and medicalized frameworks of depression, have influenced our culture How employees are increasingly pressured to be happy or perform happiness within the workplace How people receiving welfare or government benefits are required to engage in positive thinking programs or cognitive behavioral therapy That holding individuals responsible for attaining their own happiness relieves responsibility from structural and institutional determinants of well-being The coercive and forceful aspects of the “happiness industry,” including surveillance in workplaces and mandatory self-help programs in schools The role that positive thinking and self-help culture play in upholding neoliberalism and capitalism Relevant Links: Dr. Will Davies The Happiness Industry: How the Government and Big Business Sold Us Well-Being The Managed Heart: Commercialization of Human Feeling The Power Thinker: Why Foucault’s Work on Power is More Important than Ever The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age Dr. Davies’ next book, Nervous States: Democracy and the Decline of Reason will be published by Norton in early 2019. © Mad in America 2018

This week on MIA Radio, we interview Dr. Sandy Steingard. Dr. Steingard is Medical Director at Howard Center, a community mental health center where she has worked for the past 21 years. She is also Clinical Associate Professor of Psychiatry at the College of Medicine of the University of Vermont. For more than 25 years, her clinical practice has primarily included patients who have experienced psychotic states. Dr. Steingard serves as Board Chair of the Foundation for Excellence in Mental Health Care. She was named to Best Doctors in America in 2003 and writes regularly for Mad in America. She is editor of the book Critical Psychiatry, Controversies and Clinical Implications due in 2019. In this episode we discuss: What led Sandy to her career in psychiatry and her particular interest in the critical aspects of psychiatry and psychology. That Sandy’s initial interest was in biomedical explanations of psychotic experiences. How, in the late 80s, the advent of new antipsychotic drugs caused an initial excitement because of the promises made about safety and efficacy, but that Sandy came to realise the problems with the drugs. How she witnessed the over-promotion of the drugs and that the promotion was markedly different to the results of studies and her observations of patients that were taking them. How a series of disappointments and recognition of some inherent flaws in psychiatry led Sandy to her interest in alternatives. That the book, The Truth About the Drug Companies by Marcia Angel MD, had a big impact on Sandy’s view of the drugs during the 2000s. Other influential books were The Daily Meds by Melody Petersen and Side Effects by Alison Bass. That reading Anatomy of an Epidemic and particularly the problematic aspects of the long-term use of antipsychotic drugs caused Sandy to question how she was practising. That she found colleagues were sometimes angry at the conclusion that antipsychotic drugs might not be safe or lead to better outcomes for patients. That this led to the investigation of alternatives such as Open Dialog, training with Mary Olsen at the Institute of Dialogic Practice and discovering the Critical Psychiatry Network and the work of Dr. Joanna Moncreiff. How Sandy approaches practising from a critical perspective, particularly when expectations are in line with the dominant biomedical narrative. Her book, Critical Psychiatry, due in 2019 which aims to help clinicians apply transformational strategies in their clinical practices. That psychiatrists would be well served by welcoming lived experience input to their daily practice. Why informed consent should be viewed as an ongoing process rather than a one-time agreement. The problems that arise in clinical studies where experience is translated into a numerical form. Relevant links: Critical Psychiatry, Controversies and Clinical Implications (due 2019) How Well Do Neuroleptics Work? What We Are Talking About When We Talk About Community Mental Health The Truth About The Drug Companies by Marcia Angel MD (video) The Daily Meds by Melody Petersen (review) Side Effects by Alison Bass Open Dialog The Institute for Dialogic Practice Critical Psychiatry Network