Mad in America: Rethinking Mental Health

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

This week, we interview journalist and author Johann Hari. Johann is one of our foremost social science thinkers and writers. In addition to writing regularly for the New York Times and Independent newspapers, he has written extensively on social science and human rights issues. His 2015 book Chasing the Scream: The First and Last Days of the War on Drugs, challenges what we believe about addiction and his TED talk on our response to addiction has been viewed over 20 million times. Johann was twice named 'National Newspaper Journalist of the Year' by Amnesty International. And he has been named 'Cultural Commentator of the Year' and 'Environmental Commentator of the Year' at the Comment Awards. In this interview, we talk about Johann's latest book, Lost Connections: Uncovering the Real causes of Depression and the Unexpected Solutions, which has been called a 'game changer' and received plaudits for its explanation of the social and cultural issues leading to depression and anxiety. In the episode we discuss: How Johann became interested in journalism and began writing about social justice and human rights issues. What led to wanting to write a book that was partly based on his own experiences with depression and anxiety, but also that provided the evidence for social and cultural issues that may underlie the dramatic increase in the number of people needing support for emotional distress. The facts behind the chemical imbalance theory of mental illness. The role of the bio-psycho-social model of mental distress and why we may have focussed predominantly on biological interventions. Social prescribing as a means to enable connection between people who struggle with depression and anxiety. The Hamilton Depression scale and how it shows us that the effect of antidepressant drugs is small when compared to the improvements that can be achieved without drug therapy. How Johann would like to widen the definition of what may be considered an 'antidepressant'. How disempowerment often lies at the heart of poor health. How stigma relates to our perceptions of an individual who is labelled mentally ill and how it changes if we think someone has a biological problem. Johann's experiences in the Berlin district of Kotti. That people can hear audio of the many of the interviews held for the book at https://thelostconnections.com Relevant links: Lost Connections: Uncovering the Real causes of Depression and the Unexpected Solutions Johaan Hari talk at the Royal Society for the encouragement of Arts, Manufacturers and Commerce (RSA) Chasing the Scream: The First and Last Days of the War on Drugs TED Talk, Everything you think you know about addition is wrong To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018

This week on MIA Radio, we interview Kelli Foulkrod. Kelli is the owner of the Organic Mental Health Center. She is a therapist, yoga teacher, and mental health paradigm shifter based in Austin, Texas. For the past 15 years, Kelli has worked in the mental health field and practised yoga. She has been integrating yoga and the healing arts into traditional psychotherapy for over eight years and is passionate about offering holistic mental health treatment options. With many years experience in an academic research setting, Kelli bridges the gap between science and spirituality. Kelli has experience serving clients populations of pregnant and postpartum women, grief and loss, psychosis, homelessness, substance abuse, teens, couples, and groups. She offers individual, couples, and group psychotherapy services in addition to yoga therapy sessions, workshops, and retreats. In the episode we discuss: How Kelli started her journey as a psychology undergraduate at the University of Texas and working in clinical and academic research. How working in a neuroscience laboratory resulted in internal conflict and led Kelli to interest in and research into alternative modalities alongside her psychology studies. How Kelli experienced first hand the approaches that pharmaceutical manufacturers used when running clinical trials. That Kelli felt that modern psychology neglects the body and she started to practise yoga and meditation alongside studying for her masters degree in clinical psychology. That, to Kelli, modern mental health therapy feels egotistical and narcissistic and that she was resistant to becoming a clinical therapist. How people are hungry for alternatives but there are so few other options that people continue to get involved with mainstream medicine. The profound changes that occur when becoming parents and why this might lead to mental health difficulties. How we have lost touch with community and social connections that existed when we lived as tribal cultures. How shamanic ceremony and tradition can be understood and utilised in response to emotional distress. Relevant links: The Organic Mental Health Centre The Organic Mental Health Centre (Facebook) Yoga for depression - the research To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018

This week on MIA Radio, we interview Dr. Jennifer Bahr. Dr Bahr is a passionate advocate for naturopathic approaches to health and wellbeing. She is the founder of Resilience Naturopathic which was founded with a mission to not only to provide an alternative to those who struggle with mental health conditions but to improve the way mental and behavioural healthcare is delivered in America. Dr Bahr received her Doctor of Naturopathic Medicine from Southwest College of Naturopathic Medicine in Tempe, AZ. Prior to that she was an Arabic Translator for the US Government and served 6 years in the US Navy. She received her Bachelor of Science in Physiology and Neurobiology from the University of Maryland. She is the President of the California Naturopathic Doctors Association, the founding Vice President of the Psychiatric Association of Naturopathic Physicians, and a member of the House of Delegates for the American Association of Naturopathic Physicians. She previously taught at Bastyr University and is a contributing writer for Homeopathy Today, Naturopathic Doctor News and Review, Mad In America, and The Wise Mom. In the episode we discuss: How Dr. Bahr came to be involved with the psychiatric system and prescribed psychiatric drugs. That receiving a diagnosis of bipolar disorder led to fears such as loss of employment and that the condition was permanent, feeling like a life sentence. How the psychiatric drugs, including Lithium, affected Dr. Bahr's academic performance. How those experiences led to Dr. Bahr's interest and study into non-medication based and naturally oriented approaches to supporting mental health and wellbeing. Why naturopathic medicine might be a good approach for mental health issues. That it is important to choose naturopathic approaches as a first step to avoid potential harm from medications prescribed through the mainstream system. The inherent problems with clinical trials of psychiatric drugs, such as placebo washout. How supporting the whole person is the aim of naturopathic approaches and how this contrasts with the mainstream psychiatric approach of relying heavily on trying to alter brain chemistry. That we should focus heavily on what is happening in our environment to help address the alarming increase in both physical and mental health problems. How people can find out more about Dr. Bahr and her work by visiting https://resiliencenaturopathic.com. Relevant links: Resilience Naturopathic Rx Resilience: Cultivating the Ability to Bounce Back American Association for Naturopathic Physicians Institute for Natural Medicine To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018