Mad in America: Rethinking Mental Health

This week, we interview Laura Delano. Laura is Co-Founder and Executive Director of the Inner Compass Initiative and The Withdrawal Project, which aim to create safe spaces for people to connect and the opportunity to learn about and be guided through the process of getting beyond the mental health system and off psychiatric drugs.  The passion she feels for the mission and vision of ICI arises from the fourteen years she spent lost in the mental health system and the journey that she’s been on since 2010, when she chose to leave behind a “mentally ill” identity and the various treatments that came with it, and gradually began to rediscover and reconnect with who she really was and what it means to suffer, struggle, and be human in this world.  Since becoming an “ex-patient”, Laura has been writing and speaking about her personal experiences and about the broader social and political issues sitting at the heart of “mental illness” and “mental health”. Since 2011, she has worked both within and beyond the mental health system. In the Boston area, she worked for nearly two years for a large community mental health organization, providing support to and advocating for the rights of individuals in emergency rooms, psychiatric hospitals, and institutional “group home” settings. After leaving the “inside” of the mental health system, she began consulting with individuals and families seeking help during the psychiatric drug withdrawal process. Laura has also given talks and workshops in Europe and across North America, facilitated mutual-aid groups for people in withdrawal, and organized various conferences and public events such as the Mad in America International Film Festival.  In this interview, we got time to talk about Laura’s personal experiences of the mental health system and what led her to co-found the Inner Compass Initiative and The Withdrawal Project. In this episode we discuss: Laura’s experiences as a patient in the mental health system, starting treatment aged thirteen and leaving the system behind aged 27. How she spent much of that time as a compliant patient, taking the medications and following the advice of her doctors. That, by 2010, she was on 5 medications (Lithium, Abilify, Lamictal, Effexor and Ativan) and had spent the last decade becoming worse and unable to properly engage with life. How she came to read Anatomy of an Epidemic by Robert Whitaker and that it was a profound moment of realisation. That Laura decided to take control of her life and became determined to get off the drugs as quickly as possible. How traumatic it was to come to the realisation that almost everything she had been told during treatment was overly simplistic or incorrect. That Laura did experience feelings of being a victim of psychiatry, but realised that this increased her emotional dependency on psychiatry and that it was necessary to move beyond that to feel free. That these experiences made Laura passionate about her own process of healing and rediscovering herself and helping others to find their way back to themselves after being psychiatrized. That as she healed she moved into a space of acceptance and gratitude and felt that the period around three years off the drugs was when she came to feel really alive and motivated again. That Laura feels that if we are going to move beyond the mental health system, it is about helping people to realise they don't need the mainstream system and point them to alternatives at a local level and creating physical spaces where people can come together. How Laura came to co-found The Inner Compass Initiative and The Withdrawal Project which aim to create safe spaces for people to connect and the opportunity to learn about and be guided through the process of getting beyond the mental health system and off psychiatric drugs. That The Withdrawal Project was highlighted in a recent New York Times article discussing antidepressant withdrawal. How ICI and TWP present information on many aspects of psychiatric drugs and withdrawal to help guide and inform people who do want to start the journey off their psychiatric drugs and away from the mental health system. That TWP connect is a free peer to peer networking platform that allows people to connect one on one with others who have similar experiences. How a similar peer to peer system is available on ICI to enable conversations about moving beyond the mental health system. That Laura wants to encourage people not to give up because we do heal from psychiatric drugs and that we need to spread that message far and wide. The need to both learn and unlearn when approaching how we take back our power and control of our lives after psychiatric treatment. How important it is to properly prepare before starting to taper from psychiatric drugs and how the Withdrawal Project can enable that preparation. The ‘speed paradox’ when coming off psychiatric drugs. How people can find out more about The Inner Compass Initiative and The Withdrawal Project. That Laura is keen to support local community initiatives to get underway. Relevant links: The Inner Compass Initiative The Withdrawal Project TWP Connect Learn about psychiatric drug withdrawal Inner Compass Initiative’s The Withdrawal Project Gets Mention in The New York Times—Is the Tide Finally Turning? The New York Times - Many People Taking Antidepressants Discover They Cannot Quit Read more about Laura’s journey into and out of the mental health system Laura’s presentation in Alaska, 2015 Anatomy of an epidemic by Robert Whitaker

Today on MIA Radio we have a special episode which is devoted to recent developments in the UK involving a formal complaint lodged with the UK Royal College of Psychiatrists.  Professor John Read from the University of East London took time out to bring us up to date on the response to the complaint which was lodged on behalf of a group of thirty academics, psychiatrists and people with lived experience. Relevant links: Read the full reply letter on Mad in America Hear the Royal Society of Medicine’s podcast interview with Professor Wessely and Dr Clare Gerada The New York Times - Many People Taking Antidepressants Discover They Cannot Quit

This week on MIA Radio, we interview Jeffrey Michael Friedman, a clinical social worker and an activist in the psychiatric survivor's movement. Jeffrey provides trauma-informed therapy to victims of various forms of abuse and violence, including those who have survived abuses within the mental health system. In addition to his work in the mental health field, Jeffrey is actively involved in the harm reduction movement, which supports human rights and non-coercive services for people who actively use drugs. In this interview, we discuss why forced psychiatric treatment is a form of trauma and its impact on victims and their families. In this episode we discuss: How Jeffrey’s early experience with the alternative school system led to being othered and ostracized, which influenced his later involvement with the psychiatric survivor's movement. How the trauma-informed perspective offers an alternative framework to the traditional medical model of mental health. Why forced psychiatric treatment meets the definition of trauma, and more specifically, betrayal trauma. The psychological effects of involuntary commitment forced drugging and outpatient commitment. That forced treatment reinforces the notion that distress or crisis results from individual pathology rather than familial mistreatment or trauma. That victims of forced treatment may be less likely to seek medical care for physical health issues or receive proper medical treatment. How survivors can heal from forced treatment. The parallels between the harm reduction movement and the psychiatric survivor's movement, and similarities between safe consumption sites and peer services. That the addiction treatment industry, including 12-step programs, can be coercive in similar ways to the mental health system. Relevant Links: Jeffrey Michael Friedman, LCSW What is a Betrayal Trauma? What is Betrayal Trauma Theory? The Power Thinker– a brief description of Michel Foucault’s work on power and surveillance. Altruism Born of Suffering Principles of Harm Reduction Thomas Szasz: The Right to Take Drugs The Legal Industry for Kidnapping Teens – a description of the physically forceful transportation services that are sometimes utilized to transport teenagers to addiction treatment. Jeffrey Michael Friedman on SoundCloud Jeffrey can be followed on Twitter: @jmfriedman and Instagram: traumainformedpodcast Mad In America's Psychiatric Drug Withdrawal course To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018

This week, we interview Dr Russell Razzaque. Dr Razzaque currently works as a consultant psychiatrist and associate medical director in east London and, together with colleagues, he is leading a pioneering multi-centre Open Dialogue pilot in the UK National Health Service. In 2014 he released his book ‘Breaking Down Is Waking Up’ in which he explores alternative views of mental distress, their relationship to consciousness and comparisons to forms of spiritual awakening. In this interview, we discuss the relationships between mindfulness, Acceptance and Commitment Therapy and Open Dialogue and how the UK NHS is approaching the worlds first randomised controlled trial of Open Dialogue interventions for people struggling with emotional or psychological distress. In this episode we discuss: What led Dr. Razzaque to his interest in psychiatry and in particular some of the more unconventional aspects of the profession. How beginning to practice mindfulness nearly 20 years ago led to Russell starting to feel an incongruence between the dominant philosophy in psychiatry and what he was learning from his own mindfulness practices. That the dominant philosophy is one of trying to help people remove their pain and remove them from difficult and uncomfortable experiences, but in his own personal development, he was learning to sit with the pain and finding that valuable. How this led to an interest in novel therapeutic approaches like Acceptance and Commitment Therapy, originally pioneered by professor Stephen Hayes. That Russell felt disillusioned with the way that UK mental health services and systems were organised and realised that creating better outcomes for people would require system-wide change. How Russell came to be one of the leading figures in the worlds first multi-centre, fully randomised Open Dialogue Trial which seeks to establish the evidence base for Open Dialogue. That the trial involves eight NHS Trusts across the UK and that several hundred practitioners have already been trained in Open Dialogue therapy. That during the trial there will be randomly selected postcodes receiving Open Dialogue interventions compared with randomly selected postcodes receiving treatment as usual and that the results will be compared after three years. That this trial will allow us to answer questions about the efficacy of Open Dialogue because we will have built a strong evidence base. How colleagues have reacted to the Open Dialogue trial and why some might be threatened by the need to change. That Open Dialogue is a need adapted approach, so it is not fundamentally against any of the conventional interventions, but it encourages people to make their own choices, so medication use tends to significantly reduce. That it is necessary to change the power dynamic in current systems and approaches because the current methods lead to dependency, whereas Open Dialogue is about empowering and liberating the individual. That Russell is encouraged to find that many psychiatrists are willing to open up to new ways of thinking about mental and emotional distress. How spirituality and psychiatry can work hand-in-hand and how accepting spiritual explanations can sometimes lead to better understanding of personal experiences. That, in future, the system needs to change such that interpersonal relationships are put first and are seen as the key to successful outcomes. That we also need to adapt so that clinicians are trained to be present with distress and not just try to remove it.  How people can hear Russell speak at the upcoming Compassionate Mental Heath event in South Wales, being held on April 25th and 26th 2018. Relevant links: Russell Razzaque Breaking Down is Waking Up Open Dialogue trial Developing Open Dialogue Compassionate Mental Health

Dr. Duncan Double, a Consultant Psychiatrist and founder of the Critical Psychiatry Network, shares his journey from early interests in Freud to his critical stance on mainstream psychiatry. He discusses how traditional practices often overlook the personal contexts of patients. The conversation also delves into the controversial use of antidepressants and the importance of community-based care while minimizing coercive treatment methods. Double advocates for a nuanced understanding of mental health, challenging the idea that mental illness is merely a brain disease.

This week on MIA Radio, we interview Tina Minkowitz. Tina is an attorney and survivor of psychiatry who represented the World Network for Users and Survivors of Psychiatry in the drafting and negotiation of the United Nations’ Convention on the Rights of Persons with Disabilities. Tina is a strong proponent for the abolition of all forced psychiatric interventions and played a major role in attaining a shift in international law in favor of such a ban. In this interview, we talk about how the United Nations came to support the abolition of forced psychiatric treatment and why Tina believes that abolition of forced treatment, not reform, is necessary. In this episode we discuss: How Tina came to be interested in the intersection of international human rights law, disability rights law, and the issue of forced psychiatric treatment Why Tina believes in the abolition, not reform, of forced psychiatric treatment That the threat of forced treatment against some psychiatric survivors can be traumatic to the entire survivor community The barriers to the abolition of forced treatment, including public perceptions of people labeled mentally ill and lack of awareness of non-coercive alternatives That advocacy is needed to eliminate the 72-hour hold, not just ECT, forced drugging, or outpatient commitment Why forced treatment constitutes physical violence That we don’t need to put in place alternatives to the current mental health system in order to demand an immediate stop to forced treatment How mental health policy should center what we now consider alternative practices, such as peer-run services, hearing voices groups, and in-home supports How the issue of forced treatment fits within the disability rights framework Tina’s current activities with the Center for the Human Rights of Users and Survivors of Psychiatry Relevant Links: The Center for the Human Rights of Users and Survivors of Psychiatry Campaign to Support CRPD Absolute Prohibition of Commitment and Forced Treatment CRPD Course Committee on the Rights of Persons with Disabilities Convention on the Rights of Persons with Disabilities

Today on MIA Radio we have a special episode which is devoted to recent developments in the UK involving the Royal College of Psychiatrists. These events relate to the media coverage of a widely reported antidepressant meta-analysis in the Lancet, information on antidepressant withdrawal effects and a letter to The Times newspaper by the President of the Royal College Professor Wendy Burn and the Chair of the Royal College’s Psychopharmacology Committee, Professor David Baldwin. Professor John Read from the University of East London took time out to explain recent events and to talk about a formal complaint which has been lodged with the Royal College on behalf of a group of eminent psychiatrists and psychologists. Relevant links: Read the letter on Mad in America Press Release by the Council for Evidence-Based Psychiatry The Times: More People Should Get Pills to Beat Depression The Royal College’s leaflet on Antidepressant Withdrawal

This week, we interview Dr Lucy Johnstone. Lucy is a clinical psychologist, trainer, speaker and writer, and a long-standing critic of the biomedical model of psychiatry. She has worked in adult mental health settings for many years, alternating with academic posts.  Lucy has authored a number of books, including 'Users and Abusers of Psychiatry’(Routledge 2000), and ‘A Straight-talking Introduction to Psychiatric Diagnosis’ (PCCS Books 2014) as well as a number of articles and chapters on topics such as psychiatric diagnosis, formulation and the role of trauma in breakdown. She has a blog on Mad in America.  Lucy kindly took time out talk to me about the new Power Threat Meaning Framework, an ambitious attempt to outline a conceptual alternative to psychiatric diagnosis which was published on January 12th this year by the Division of Clinical Psychology of the British Psychological Society. In this episode we discuss: Lucy’s background and what led her to be interested in mental health work, particularly in terms of being critical of current practice. The importance of acknowledging the reality of people’s experiences of distress along with questioning the dominant explanations for that distress. The fact that the diagnostic model has never been supported by evidence. How imposing a diagnosis often can be very damaging to people, by turning ‘people with problems’ into ‘patients with illnesses.’ Why we need to move towards the survivor slogan of “Instead of asking “What is wrong with you?” ask “What has happened to you?”’ The inception of the Power Threat Meaning Framework, which was funded by the Division of Clinical Psychology of the British Psychological Society, and the five-year journey to its release earlier this year. The composition of the core project team: Lucy, Mary Boyle, John Cromby, Jacqui Dillon, John Read, Peter Kinderman, Eleanor Longden, Dave Harper, Dave Pilgrim and a research assistant Kate Allsopp. The core team consists of psychologists and survivors/campaigners, many of whom are well known to MIA readers. Also involved were a consultancy group of service users/carers; a group of critical readers with a particular focus on diversity; and a number of others who contributed to particular sections or supplied good practice examples. How the Framework itself is not an official DCP or BPS position or policy document, nor is it a plan for services or for any other specific form of implementation. Rather, it is offered as a co-produced academic and conceptual resource to anyone who wishes to take on these ideas and principles and develop them further or translate them into practice. The Framework is necessarily dense because of its aim to move right away from the “DSM/ICD mindset” which is deeply rooted in Western culture. However, there are various accessible summaries of its core principles (see below.) How we already have a number of ways of supporting someone non-diagnostically, but what we didn't have before was a sound, evidence-based alternative to what diagnosis claims, but fails to do, which is to outline patterns in distress. How the Framework acknowledges the irreducible complexity of a person’s responses to their circumstances. The derivation of the title: The Power Threat Meaning Framework. The four main questions, which are: What has happened to you? Translated as “How is Power operating in your life?” How did it affect you? Translated as “What kinds of Threats does this pose?” What sense did you make of it? Translated as “What is the Meaning of these situations and experiences to you?” What did you have to do to survive? Translated as “What kinds of Threat Response are you using?” Finally “What are your strengths?” or “What access to Power resources do you have?” and to pull it all together, “What is your story?” These are not separate questions, since each of them implies and arises out of the others. That the aim is for people to be able to use these ideas and questions for themselves, not necessarily through an interaction with a professional. How the PTM Framework does not recognise a separate group of people who are ‘mentally ill’ but describes how we are all subject to, and affected by, the negative impact of power in some aspects of our lives. How it is particularly important to recognise the role of ideological power, or power over language, meaning and agendas. How the PTM Framework includes the concept of formulation, which is a semi-structured way of putting together someone’s story, but is much wider in scope and for that reason uses the preferred term “narrative” – which may be individual, group or community. How diagnosis often obscures someone's story, and how the Framework aims to help create narratives that restore the links between personal distress and social injustice. What the PTM Framework says about DSM and ICD attitudes to conceptualisations of distress in non-Western cultures. That since we are meaning-making creatures, at a very basic level the principles of power, threat, meaning and threat response apply across time and across cultures, although all expressions and experiences of distress are culturally-shaped. The regrettable exporting of Western psychiatric models across the world. How the Framework does not exclude or deny the role of biology, but integrates it as a mediator and enabler of all human experience, although not something that is always accurate or helpful to view as a primary cause. The reaction to the Framework, both positive and negative. The team very much welcomes feedback, much of which has been very helpful. Some of the more extreme reactions can be understood as predictable responses to the threat posed by the Framework to ideological power. How the reaction outside social media has been overwhelmingly positive. Emphasising again that the Framework is (unlike diagnosis) presented as a completely optional set of ideas, and a work in progress. The project team is very pleased that there is such widespread interest in taking these ideas forward in people’s own lives and settings. People are encouraged to explore these ideas for themselves via the links below. More resources will be added in due course. Relevant links: PTM Framework Introduction and Frequently Asked Questions The above link will take you to the following: Power Threat Meaning Framework Main document Power Threat Meaning Framework Overview PTM Framework Guided Discussion for applying these ideas to your own life or someone you are working with Presentation slides from the PTM Framework launch The Power Threat Meaning Framework 2 page summary You may also be interested in these articles and blogs on the Framework: Publication of the Power Threat Meaning Framework: Mad in America blog A mental health nurse’s first response to the launch of the Power Threat Meaning Framework My mother took her own life – and now I know a different mental health approach could have saved her An Alternative to Psychiatric Diagnosis? The PTM Framework, where do we go from here? I’ve Been Waiting for this Since I Was a Child The Power Threat Meaning Framework: a radically different perspective on mental health Lucy’s interview on Let’s Talk Withdrawal can be found here: Lucy’s interview on Let’s Talk Withdrawal (April 2017) To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018    

This week, we interview Dr Joanna Moncrieff. Dr Moncrieff is a psychiatrist, academic and author. She has an interest in the history, philosophy and politics of psychiatry, and particularly in the use, misuse and misrepresentation of psychiatric drugs. As an author, Dr Moncrieff has written extensively on psychiatric drugs and her books include The Myth of the Chemical Cure, A Straight Talking Introduction to Psychiatric Drugs and The Bitterest Pills: the troubling story of antipsychotic drugs. She is one of the founding members of the Critical Psychiatry Network which consists of psychiatrists from around the world who are sceptical of the idea that mental disorders are simply brain diseases and of the dominance of the pharmaceutical industry. We talk about the recent meta-analysis of the efficacy and tolerability of 21 antidepressant drugs, widely reported in the UK news media on February 22nd. In the episode we discuss: The approach taken in the largest ever meta-analysis of efficacy and tolerability of 21 common antidepressant drugs. The problems inherent in comparing antidepressants with each other, as opposed to trials that compare the active drug to a placebo. That the main conclusion reached was that all the antidepressants studied were better than placebo at reducing depressive symptoms. The limitations of the study, particularly how response rate was selected as the primary outcome measure. That ‘response’  is mostly defined as a reduction in the Hamilton Depression Rating Scale (or other scale) rating of 50% or more during the study. That the response rate can artificially inflate the difference between drug and placebo. The problems with blinding in the supporting trials and the effects of including people who are already receiving antidepressant treatment. That the study did not include adverse effects or withdrawal difficulties, only dropout rates which are not representative of the whole picture of taking the drugs. The short-term nature of the supporting trials, mainly 8 weeks, with a range of 4 to 12 weeks, which cannot be easily compared with the real world experience of people taking the drugs for much longer periods. That, when the primary data is analysed (the depression rating scale scores)  the differences between placebo and antidepressants are very small and probably clinically insignificant. The uncritical and sensational nature of the media reporting of the study and the link to the Science Media Centre. The concerns about the reporting that depression is under-treated in the UK which is not supported by the results of the study. That people should carefully consider the balance of benefit versus risk, taking into account the potential for adverse effects or difficulties stopping the drugs. Relevant links: Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis Challenging the New Hype About Antidepressants The Hamilton Depression Scale Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences Efficacy of antidepressants in adults The Science Media Centre

This week, we interview Professor Michael Fontaine. Michael is Professor of Classics and Associate Vice Provost of Undergraduate Education at Cornell University in New York. He regularly consults on Latin for museums, institutions, dealers, and collectors, having exposed forgery in Renaissance and Dutch Golden Age paintings. In 2016 he received the Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties. In the episode we discuss: How Michael came to be a Professor of Classics and Literature. How studying the ancient world helps us to understand what the first scientists thought about mental or emotional distress. The first use of the phrase ‘psychiatric ward’ which can be found at the Library of Alexandria in Northern Egypt. That the phrase that ultimately became the word ‘Psychiatry’ in ancient times actually meant a “Healing Place for the Soul” and is inscribed above library entrances even today (ΨΥΧΗΣ ΙΑΤΡΕΙΟΝ or Psyches iatreion). The links between the Rosenhan experiment and a comedic play written 2,200 years ago by the ancient Roman playwright T. Maccius Plautus. That, in the ancient world, there was no long term incarceration in prisons or asylums. The relationship between the Hippocratic/medical model (the humoral theory) and the Epicurean model of mental or emotional distress. That, in the ancient world, depression didn’t exist, and that the solutions for unhappiness were based in the community or in Philosophy. That about 1700 years ago, the Roman Empire entered a state of decline and it became mandatory to become Christian and during this time the philosophical view of mental distress died away to be overtaken by a supernatural understanding. Some of the similarities between the Epicurean model and the work of Thomas Szasz. How Michael came to know and discuss some of these matters with Thomas Szasz and, following his suicide in 2012, presented an academic paper to the American Psychiatric Association on Thomas Szasz’ legacy. The statistics that show that one in every four women around middle age in the US is taking an antidepressant. Michael’s essay on Schizophrenia in the ancient world. The distinction between the causes of, and the reasons for, our behaviour. Ron Leifer having his career ruined because of his support for the ideas of Thomas Szasz. A poem from 2,100 years ago by the Latin poet Catullus, that deals with transgender identity, even though it is generally believed that gender identity issues are a recent phenomenon (last 50 years or so). How Greek Tragedy can help us understand the world, particularly those of Euripides such as Medea Relevant links: On Being Sane in an Insane Place—The Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus On Religious and Psychiatric Atheism: The Success of Epicurus, the Failure of Thomas Szasz Thomas Szasz Mental Disorders in the Classical World (A Review) Schizophrenia in the Golden Ass What Do the DSM, Elvis Presley, and Dionysus Have in Common? To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018