Mad in America: Rethinking Mental Health

This week I have had the honour of interviewing Dr Irving Kirsch. Dr Kirsch is Associate Director of the Program in Placebo Studies and lecturer in medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center. He is also Professor Emeritus of Psychology at the University of Plymouth and the University of Hull in the UK and University of Connecticut in the US. He has published 10 books and more than 250 scientific journal articles and book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. He originated the concept of response expectancy. His meta-analyses on the efficacy of antidepressants were covered extensively in the international media and influenced official guidelines for the treatment of depression in the United Kingdom. His 2009 book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, was shortlisted for the prestigious Mind Book of the Year award and was the topic of 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In this interview, we discuss Dr Kirsch’s research into the placebo effect and the efficacy of drugs used for depression. In this episode we discuss: How, as an undergraduate student, Dr Kirsch became interested in behavioural therapy but that he doubted the rationale behind these approaches That this led to an interest in beliefs that people had and research into the placebo effect How, while working at the University of Connecticut, his research into the placebo led to an interest in the efficacy of antidepressant drugs when compared to placebo How his work led to the surprising conclusion that, were antidepressant drugs were concerned, the placebo effect was so large that there was very little room for a meaningful drug effect How this changed Dr Kirsch’s views on antidepressant drugs entirely, causing him to ask whether the risks were worth the small benefit for depressed patients That a belief that a person has can affect their response to a drug either in a positive way (placebo) or in a negative way (nocebo) Dr Kirsch found that there are many conditions that can show a profound placebo effect including depression, anxiety, irritable bowel syndrome, pain, Parkinson’s disease and asthma  That the placebo tends to have a greater effect in conditions that have a large psychological component when compared to functional disorders such as diabetes That placebo can have an effect even if the patient knows that they are taking an inactive tablet and that part of this response is down to classical conditioning That Dr Kirsch is working on ‘open-label placebo’ which is being able to prescribe placebo to patients without deception That Dr Kirsch used to refer depressed patients for antidepressant treatments, but that his research made him a disbeliever when looking at the evidence of efficacy when compared to placebo How, when you give someone a new treatment, that often will counter feelings of hopelessness that characterise depressive experiences That in looking at this size of this effect, it made clear that the difference between placebo response and antidepressant response was so small that it was not clinically significant That even drugs with very different modes of action resulted in virtually identical responses in patients, for example, Tianeptine, which is an SSRE (selective serotonin reuptake enhancer) and decreases serotonin levels between neurons, this drug should make depressed people worse but instead, it showed the same efficacy as SSRI antidepressants How, when looking at the clinical trials used to demonstrate antidepressant efficacy, it became clear that the obvious nature of antidepressant adverse effects meant that trial participants would often “break blind” and they would know if they were in the active drug group or the placebo group, this would naturally influence the results of the trial That, in a small number of studies, an active placebo was used, which was a substance that mimicked the side effects of the active drug while having no clinical effect itself That in these active placebo studies, you were much less likely to get a significant difference between drug and placebo when compared to trials that used an intern placebo That the trials conducted by pharmaceutical manufacturers are designed to show their drug in the best possible light and so they do not use active placebo in their studies That Dr Kirsch feels that when conducting trials for drugs used for depression, patients should be asked early on in the trial whether they think they are in the active group or the placebo group and that this question would help ensure the trials were reliable How, when using the data from unpublished trials, the difference between placebo effect and drug effect was even smaller How Dr Kirsch was pleased that other researchers found his conclusions controversial because it meant that they were paying attention to the study and that others who have replicated the approach have found similar results That influencing clinicians to better balance risk vs benefit will take time and that we need to share the data and discuss the conclusions as much as we can to allow change to happen  That people do need help with depression and that there are many different interventions that are at least as effective as antidepressants but without the associated risk How we can’t infer that ‘off-label’ prescribing is effective until the studies have been undertaken for a particular disorder Relevant Links: Dr Irving Kirsch The Emperor’s New Drugs: Exploding the Antidepressant Myth The Emperor’s New Drugs: Exploding the Antidepressant Myth (video) 60 Minutes: Treating Depression: Is there a placebo effect? (video) Antidepressants and the Placebo Effect Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017  

This week we have a very special guest for you, it has been my honour to be able to interview Dr. Peter Breggin. Dr. Breggin is a Harvard-trained psychiatrist and former Consultant at the National Institute of Mental Health (NIMH). He has been called “The Conscience of Psychiatry” for his many decades of successful efforts to reform the mental health field. His work provides the foundation for modern criticism of psychiatric diagnoses and drugs, and leads the way in promoting more caring and effective therapies. His research and educational projects have brought about major changes in the FDA-approved Full Prescribing Information or labels for dozens of antipsychotic and antidepressant drugs. He continues to educate the public and professions about the tragic psychiatric drugging of America’s children. He has authored dozens of scientific articles and more than twenty books, including medical books and the bestsellers Toxic Psychiatry and Talking Back to Prozac. His most recent three books are Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions; Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Murder; and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families. As a medical-legal expert, Dr. Breggin has unprecedented and unique knowledge about how the pharmaceutical industry too often commits fraud in researching and marketing psychiatric drugs. He has testified many times in malpractice, product liability and criminal cases, often in relation to adverse drug effects and more occasionally electroshock and psychosurgery. A list of his trial testimony since 1985 is contained in the last section of his Resume on Dr. Breggin's website. Dr. Breggin has taught at many universities and has a private practice of psychiatry in Ithaca, New York. For a career as long and distinguished as Dr. Breggin’s we have decided to devote two episodes to hearing him speak. This first part covered Dr. Breggin's career, his views on psychiatry and psychiatric drugs and also recent developments with the trial involving Michelle Carter. Part 2 of the interview focuses more on recent events surrounding the trial and alternatives to psychiatric drugs. In this episode, we discuss: That Bristol County Juvenile Court Judge Lawrence Moniz sentenced Michelle Carter to a two-and-a-half-year term, with 15 months in jail and the balance suspended plus a period of supervised probation.  How Judge Moniz granted a defense motion to stay the sentence, meaning she will remain free pending her appeals in Massachusetts. That if Michelle lost all of her appeals in 2-3 years time, Michelle may be facing custodial time. That attempts to limit Dr. Breggin’s right to blog about the trial were stopped and the Judge’s final order in response to DA makes no criticism or censorship of Dr. Breggin That Dr. Breggin reviewed thousands of text messages between Michelle and her friends and between Michelle and Conrad Roy, but that one particular part of a text exchange formed the central plank of the case against Michelle. That Dr. Breggin is keen to show, through the Michelle Carter blogs, what is happening to our children when they become involved with psychiatry and psychiatric drugs That Dr. Breggin appreciates the suffering of the family of Conrad Roy because he kept hidden how bad his mental health difficulties were How Dr. Breggin also appreciates how Michele had been tormented and attacked by the press during the trial How the authorities went to extremes to exclude the role that psychiatric drugs may have played in the events surrounding Michelle and Conrad That Dr. Breggin has observed that many that he has helped that have been wounded by psychiatry, have shied away from becoming reformers themselves How, when working with clients, Dr. Breggin makes sure he takes the time to ensure that potential clients know who he is and how his approach differs to mainstream psychiatry That Dr. Breggin feels that the hostility towards those who question the use of psychiatric drugs has reduced over the last 10 to 20 years How Dr. Breggin feels that the psychiatric drugging of our children is tantamount to organised child abuse because the child cannot make a judgement for themselves That many children end up taking the drugs to please their parents That the drug that Michelle Carter was taking (Celexa/Citalopram) was not approved by the FDA for treating children That Dr. Breggin’s view is that emotional or psychological difficulties often are precipitated by childhood trauma That people often then react to the current world as if it were the world that they found traumatic and difficult as a child That good therapy has much in common with coaching in sport or certain aspects of religion or good teaching That all psychoactive substances, including psychiatric drugs, have a general effect on the brain and often this intoxication affects a persons ability to relate emotionally to family and friends How helping people with their mental health comes down to loving, caring, relationship, coaching and guidance That these principles have much in common with good religion or philosophy Relevant Links Peter Breggin’s personal website Peter’s blogs on Mad in America: Part 1 Part 2 Part 3 Part 4 Part 5 Michelle Carter Blogs and Archives The handwritten note from the DA to the Judge about stopping Dr. Breggin’s blog Judge’s Final Order in Response to DA Makes No Criticism or Censorship of Dr. Breggin Toxic Psychiatry Talking Back to Prozac Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Murder Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This week we have an interview with Professor John Read. Professor Read worked for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, where he worked until 2013.  He has served as Director of the Clinical Psychology professional graduate programmes at both Auckland and, more recently, the University of Liverpool. He has published over 120 papers in research journals, primarily on the relationship between adverse life events (eg child abuse/neglect, poverty etc.) and psychosis. He also researches the negative effects of bio-genetic causal explanations on prejudice, the opinions and experiences of recipients of anti-psychotic and anti-depressant medication, and the role of the pharmaceutical industry in mental health research and practice. John is on the Executive Committee of the International Society for Psychological and Social Approaches to Psychosis (www.isps.org) and is the Editor of the ISPS’s scientific journal ‘Psychosis’. He also a member of the BPS’s Alternatives to Diagnosis working group. In this episode we discuss professor Read’s research interests and in particular, the science and evidence base for Electroconvulsive Therapy or Electroshock as its known in the United States. In this episode we discuss: How Professor Read became interested in psychology, partly because of difficulties in his younger years and he wanted to understand those experiences That his first experiences with patients in a psychiatric ward would be that people often wanted to share traumatic experiences, but that the psychiatrists didn't seem that interested That, by and large, mental health services around the world prefer to count symptoms and to medicate rather than to understand what has happened in a person’s life How John came to have an interest in and research the efficacy and safety of Electroconvulsive Therapy (Electroshock) That ECT is designed to induce a grand mal seizure and it started as a treatment for people diagnosed as schizophrenic That the justification in the 1940s was that schizophrenics did not suffer with epilepsy and epileptics did not suffer with schizophrenia, so psychiatry made the leap to inducing epileptic seizures as a ‘cure’ for schizophrenia That nowadays it is not used for people labelled as schizophrenic but it is most often used for treating depression How actually it is not the diagnosis that is the best predictor of who gets ECT, it’s age and gender Women aged over 60 are twice as often given ECT as men, and people over 60 are given it 2-3 times more often as those under 60 That the other rationale given for ECT treatment is the tendency for ECT to obscure traumatic memories because of memory loss That the science and evidence tells us that after 70 years there has never been a single study showing that ECT is better than placebo beyond the end of the treatment period That placebo in this sense is like sham surgery, the anaesthetic is given but not the electricity That during the treatment (usually 3-4 weeks and an average of 8-10 sessions) roughly a third of those treated gain some lift of mood but that even for this minority of responders, the effect wears off after a few weeks That this explains why some people will give anecdotal evidence that ECT saved their life and that they tend to have repeated treatments because they want the same life of mood That the method used to assess success of the procedure is most often a rating scale or a ‘clinical judgement scale’ and these methods are open to bias That there is not a single study that has ever shown that ECT can ‘prevent suicide’ when compared to placebo, the claims that it can are based on anecdotal evidence That Earnest Hemingway killed himself shortly after receiving ECT saying “it was a brilliant cure, but unfortunately we lost the patient” That there are temporary effects such as headaches after the procedure, but the enduring difficulties are often with memory loss which can be short term or longer term memories Roughly a third of people will have serious, debilitating and ongoing memory loss which is caused by the brain damage caused by ECT That the Guardian newspaper reported in April 2017 that ECT use was increasing in the UK but that their figures were wrong That a third of psychiatrists will use ECT, a third will only use it after other options have been explored and a third will not use it under any circumstances That ECT can get catatonic people moving and speaking but it is not difficult to artificially stimulate mood and it should not be seen as a cure That there haven't been any placebo controlled trials of ECT since 1985 and that was the last of only four that have ever been done that compared ECT with placebo after the end of treatment How the fact that we do not have any successful trials showing that ECT is effective should mean that psychiatry either puts effort into proper research or that the procedure should be stopped That John feels that eventually we will look back at ECT in the same way that we now view lobotomy, blood letting, rotating chairs and the like How the principle should be informed consent and that people should be able to get treatment that they feel will help them but only if they know fully the risks and benefits and if they have been offered alternatives There is a low but signifiant death rate from ECT, partly down to the general anaesthetic and partly due to cardiovascular failure because of the induced seizure but this death rate is never mentioned to potential patients That it is probably down to the placebo effect of having attention and a procedure that expectations are created and hope is raised That there is effort being put now into transcranial magnetic stimulation (TMS) and people can actually shock themselves using this method That if we have large numbers of people walking round depressed, we really need to start asking questions about our society rather than trying to artificially eradicate those feelings That John’s view is that depression is largely cause by depressing things happening to people rather than because of depressive illness and assuming that we can identify the parts of the brain that are ‘diseased’ To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This week we have an interview with Bobby Fiddaman. Bobby is a very well known author, blogger and researcher who has been writing about psychiatric drugs and the many issues involved for over 11 years. In 2011 he released his book, ‘The Evidence, However, Is Clear…The Seroxat Scandal’ which is a powerful and explosive account of his experiences taking and withdrawing from the antidepressant Seroxat.  He is a rockstar of the movement to expose the truth about psychiatric drugs, to many he is a hero and to some, he is an uncompromising agitator. His blog has been viewed over 2 million times and he is respected by many and also well known by the pharmaceutical regulators and many of the pharmaceutical manufacturers too.  I was keen to ask Bobby about his own experiences of the mental health system, his research and campaigning over the years and his relationships with the UK and US pharmaceutical regulatory bodies. In this episode we discuss: How, in the late 1990s, Bobby had health problems which made working difficult and this led to low mood and a doctor prescribing Seroxat (Paxil, Aropax, Paroxetine) How he felt that his moods and emotions were blunted by the drug and he recalls not feeling empathy or emotion That eventually his pay was stopped and he was retired on ill health grounds but by this time his financial position was difficult and he became divorced That Bobby took 21 months to wean himself off the Seroxat using a liquid form, going from 40 milligrams to 22 milligrams a day over 19 months That he then quit cold turkey, against doctor advice, because he just want to get rid of the stranglehold that the drug had on him How Bobby felt that his short term memory was affected by being on the drug That sometimes it is harder for friends and family to experience someone going through withdrawal, because they don't know what is happening to the person that they love That these experiences promoted Bobby to write his 2011 book, ‘The Evidence, However, Is Clear…The Seroxat Scandal’ How Bobby stumbled across an article by the investigative journalist Evelyn Pringle and that set the ball rolling with his own blog How Bobby’s blog started to cover the experiences of families who had experienced tragedy due to psychiatric drugs That the blog hosts guest writers so people can tell their own story in their own words How Bobby knows that the pharmaceutical manufacturers and the regulators are regular visitors to his blog That Bobby has been told that his blog makes GlaxoSmithKline ‘cringe’ and this is a measure of the impact of his work That Bobby feels that the manufacturers should just come clean and let the truth come out about the drugs, the clinical trials, the adverse effects and the withdrawal problems That many people don't understand that compensation and out of court settlements often just allow the truth to remain hidden How Bobby was present for the entire trial between Wendy Dolin and GlaxoSmithKline and was shocked by the behaviour of GSKs attorneys That the term ‘akathisia’ is not well known but is implicated in many suicides related to antidepressant and antipsychotic drugs That doctors need to listen to patients to understand the wide range of effects of the drugs That Bobby feels that the regulators, particularly the UK MHRA, should hang their heads in shame because they know about the problems with the drugs but do nothing in response That there is an incestuous relationship between the pharmaceutical manufacturers and the regulators How Bobby has had several meetings with the MHRA over the years, including meeting the CEO, but he feels that they meet to appease rather than take action in response to concerns That Bobby also set up a meeting between MHRA and Dr. David Healy  That the regulators are totally funded by the pharmaceutical industry How Bobby now highlights celebrities who promote the chemical imbalance theory of mental illness That social media has had a big impact on the ability of people to get together and share experiences and make their voices heard How the MHRA Yellow Card scheme is meant to work How, when you start asking questions about follow up, you find that no action is taken and the database of adverse events is worthless That nowhere on the labelling is a list of the benefits of antidepressant drugs That in order to make the drugs safer, we should listen to patient concerns That Bobby uses humour as a tool for getting the message heard How Bobby would like to encourage others to write about their experiences To get in touch with us email: podcasts@madinamerica.com   © Mad in America 2017  

This week we have a very special guest for you, it has been my honour to be able to interview Dr. Peter Breggin. Dr. Breggin is a Harvard-trained psychiatrist and former Consultant at the National Institute of Mental Health (NIMH). He has been called “The Conscience of Psychiatry” for his many decades of successful efforts to reform the mental health field. His work provides the foundation for modern criticism of psychiatric diagnoses and drugs, and leads the way in promoting more caring and effective therapies. His research and educational projects have brought about major changes in the FDA-approved Full Prescribing Information or labels for dozens of antipsychotic and antidepressant drugs. He continues to educate the public and professions about the tragic psychiatric drugging of America’s children. He has authored dozens of scientific articles and more than twenty books, including medical books and the bestsellers Toxic Psychiatry and Talking Back to Prozac. His most recent three books are Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions; Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Murder; and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families. As a medical-legal expert, Dr. Breggin has unprecedented and unique knowledge about how the pharmaceutical industry too often commits fraud in researching and marketing psychiatric drugs. He has testified many times in malpractice, product liability and criminal cases, often in relation to adverse drug effects and more occasionally electroshock and psychosurgery. A list of his trial testimony since 1985 is contained in the last section of his Resume on Dr. Breggin's website. Dr. Breggin has taught at many universities and has a private practice of psychiatry in Ithaca, New York. For a career as long and distinguished as Dr. Breggin’s we have decided to devote two episodes to hearing him speak. This first part covers Dr. Breggin's career, his views on psychiatry and psychiatric drugs and also recent developments with the trial involving Michelle Carter. Part 2 of the interview will focus more on the trial and Dr. Breggin’s involvement. In this episode, we discuss: How, age just 18, Dr. Breggin worked as a volunteer in a metropolitan state hospital in 1954. That his immediate impression was a comparison with German concentration camps as he witnessed the brutality including lobotomy and insulin coma therapy. How when the drugs were introduced, primarily Thorazine, the patients would quieten, becoming docile and obedient. That this was brain damage for the purpose of control. That Dr. Breggin then wanted to go to medical school and become part of the reform movement. That, in the 1950s, there were still psychiatrists that had an interest and training in  psychological therapy or psychoanalytic approaches, and social and community psychology. That this also resulted in psychiatry becoming very hostile towards psychosocial approaches, which were less expensive and better. Then, in the 1960s, psychiatry went into partnership with the drug companies and got richer. That Dr. Breggin then entered private practice and learned that lobotomy was making a comeback. This led to a multi year, international campaign to halt the use of lobotomy and psychosurgery in the western world. Since then, Dr. Breggin has also campaigned tirelessly to make changes in the FDA labelling of psychotropic drugs. That Dr. Breggin feels blessed to have been able to stand up for others but also occasionally feels worried by the attacks from the psychiatric establishment. How Dr. Breggin feels that we should tell the truth about psychiatric drugs and that claims of ‘scaremongering’ is a mechanism to reduce criticism of the drugs. That informing people is very different compared to frightening them. That each individual person is still the best judge of when and how to go about withdrawing from psychiatric medications. That Dr. Breggin feels that psychiatry has no economic incentive to change, so the consumer has to stop going to psychiatrists for medications. How the District Attorney in the Michelle Carter case is now trying to stop Dr. Breggin's Mad in America blogs about her case. Relevant Links Peter Breggin’s personal website Dr. Breggin’s blogs on Mad in America: Part 1 Part 2 Michelle Carter Blogs and Archives The handwritten note from the DA to the Judge about stopping Dr. Breggin’s blog Toxic Psychiatry Talking Back to Prozac Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Murder Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families. To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This week, we interview Dr. Rani Bora.  Dr. Bora is a qualified Psychiatrist and Mental Health and Resilience Coach. She has studied a number of approaches to mental well-being – both traditional and non-traditional, and she focuses on holistic approaches to supporting people with their mental wellness. Since deepening her own understanding of the paradigm of ‘Innate Health and Resilience’, she has committed herself to sharing this understanding in her coaching and training and has witnessed remarkable transformation in individuals whom she has supported. In this interview we discuss Dr. Bora’s background in psychiatry, how she came to move away from more traditional psychiatric approaches and the concept of innate health and resilience. In this episode, we discuss: How Dr. Bora graduated from medical school in 1997 and became interested in connecting with people leading to specialising in psychiatry That Rani found working in India as a psychiatrist very different compared to the UK and there were very few community services with most services delivered in a hospital setting That after working in the UK, Dr. Bora became interested in self help and personal development That this led to training in parallel both as a psychiatrist and as a life coach studying Neuro Linguistic Programming (NLP), Emotional Freedom Techniques (EFT) and Narrative Coaching That Rani came to see that using tools and techniques as a quick fix can be problematic, because difficulties can re-surface once people stop using the tools and techniques That Innate health and resilience (also known as the three principles) is a new paradigm pointing to the health and wellbeing within all and how the mind works That the three principles are mind, thought and consciousness That Rani sees medication and mindfulness as tools but they don’t really address the root cause of emotional distress That having an understanding about how the mind works can help people to heal from emotional difficulties or trauma That people are more resourceful than they think they are and Rani helps people to discover that resourcefulness within themselves Rani’s mentor, US Psychiatrist Dr. Bill Pettit, reminds us that a diagnosis doesn't define a person, only describes symptoms That people experiencing mental health difficulties are not different to the rest of society, but medicine quite often labels and separates Rani believes that “you cannot fail at being yourself” That if people accept themselves with their perceived flaws and limitations and realise that these individual differences are what make us unique and human, it means less judgement and self criticism That Rani feels that we focus too much on what is lacking in people and on diseases and symptoms That we also focus too much on mental illness rather than mental health That Rani does work with clients who expect medication, but that she often finds other ways to work with people That Rani wants to know the outcome people are looking for and often finds that the medical model has its limitation in helping people with their real needs in life That Rani would like the research to focus more on empowering people and what helps people recover That Rani feels that it’s very important that we also focus on the health of those in the medical community who are supporting others, as the lack of resources can be associated with enormous strain and stress That Rani would like people to reflect on the fact that they are not broken, even given what happened in the past or what diagnoses they have There is something at the core of who we are that cannot be damaged by our experiences To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

Professor Jim van Os, an influential figure in the field of psychiatry, challenges the notions of biological psychiatry and diagnostic labels. He advocates for patient empowerment, a community-based approach, and the importance of monitoring experiences and tapering off medication in mental health. The episode also highlights the benefits of a shared approach and announces updated medication withdrawal resources.

This week, we interview Kermit Cole. Kermit’s first career was in film and television, directing, amongst others, Living Proof: HIV and the Pursuit of Happiness in 1994. Kermit has undergraduate and master’s degrees in psychology from Harvard and he has over two decades experience working with people in extreme states. He likes to say that he likes to work with trauma, especially when it’s being called something else – such as “psychosis”. Together with his partner Louisa Putnam, he works with couples and families with members who have been labeled as having a mental illness, seeking other ways to understand their struggles – ways that often lead to better outcomes. Kermit has been part of the team at Mad in America since it was founded in January 2012. I was keen to ask Kermit about what led to his interest in therapeutic work, his experiences of supporting those in extreme states and his thoughts on Open Dialogue and dialogical approaches in general. In this episode, we discuss: How Kermit came to be involved with a photo project that aimed to change the dominant image usually portrayed for those with HIV or AIDS and how that led to his 1994 film: Living Proof: HIV and the Pursuit of Happiness How Kermit came to feel that a persons life should not be appraised based on its duration How Kermit went on to make the transition from film maker to supporting others with their mental health and wellbeing That Kermit came to feel that having a camera got in the way of the connection that he wanted to make with people How he went back to study and developed an interest in trauma and its impact on people and came to develop the skills necessary to be comfortable dealing with extreme states  His experiences working on a helpline for people experiencing suicidal thoughts and in a group home setting How it felt to support those in distress without judgement or control, but just being with them and how not being alone sometimes makes a big difference How sometimes supporting someone means not judging but also not colluding with beliefs that may come across as delusional, and how this is different to the approach of trying to medicate away behaviour that has been classified as aberrant That Kermit feels blessed that he could choose between schooling and study or the risk of depression, diagnosis and hospital, but that many are not so fortunate How Kermit and Louisa work together to support people struggling with their mental health through a family therapeutic approach and based on Open Dialog principles That it is important to respond to a network that is in crisis, such as the family unit, rather than a single individual That this approach used in Tornio, Finland resulted in excellent outcomes for patients and a lowering of municipal expenditure on mental health crises  How Louisa and Kermit approach working together in an open dialog model How, if you can find a way for people to safely do what they would naturally want to do, then it can be helpful How Kermit became involved with Mad in America after reading Robert Whitaker’s books That taking medication could almost be viewed as an act of communion That life, being human, hurts, but by learning to connect we can ameliorate the trauma  To listen on Mad in America: https://goo.gl/tyyLmt Podcast show notes: https://goo.gl/AiNFNk To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This week, we interview Dr. Pratima Singh. Dr. Singh completed her medical degree in India, before moving to the UK to work at the Maudsley NHS Hospital in London as an adult Psychiatrist. Dr. Singh has a deep interest in alternatives to biological approaches to psychiatry and the use of psychotropic medications. I was keen to ask Dr. Singh about her background, what led her towards psychiatry as a medical speciality and what she feels about the future of psychiatric care. In this episode, we discuss: ▪How Dr. Singh completed her medical degree in India and became interested in psychiatry  ▪That Dr. Singh felt uncomfortable with the predominantly biological approach to psychiatry including the use of medications and that her interest was in psychotherapy as a therapeutic intervention ▪That there is a recruitment and retention problem within psychiatry ▪That 15 years in psychiatry has given Dr. Singh a nuanced and humble attitude to helping people with their mental health ▪That Dr. Singh felt that her discontent with biological psychiatry continued during her training ▪That, in the UK, General Practitioners (family doctors) actually deal with 80% of mental health problems ▪Patients may then be referred by the GP to therapy teams in secondary care, commonly known as Community Mental Health Teams (CMHT) ▪These teams include psychiatrists, occupational health specialists to try and address a range of service user needs ▪That there is also acute care, or crisis teams, where support is given for psychiatric emergencies ▪Recently there has been diversification to include specialisms like eating disorders, learning disabilities or neuropsychiatry but provision differs across the UK ▪That Dr. Singh feels that we have too rapidly and too dramatically cut down the amount of in-patient beds, leaving a gap and increasing the pressure on the community teams ▪That in the UK we struggle to provide a brief intervention model because many service users often require more time ▪That Dr. Singh feels that the majority of people that she sees have already been put onto psychotropic medications by their GP and often this is too early in the process ▪That there are patients now that say they do to want to try medication ▪That the evidence for using so much medication for emotional distress is weak ▪That psychiatrists do not have tests to help predict how a medication will affect a patient or if they will struggle to withdraw ▪That Dr. Singh would like us to understand the medications better especially why some people struggle even if they try to withdraw slowly ▪That, as professionals we need to listen to patients experiences of adverse effects or withdrawal difficulties  ▪That Dr. Singh feels that it is a privilege to be able to engage with patients in this way but that we must be very carful not take advantage or to harm the patient despite our best intentions ▪That we need a completely different mindset to better manage mental health difficulties ▪That Dr. Singh prefers to look at the wider issues in a persons life to try and find the best way to support them including diet, exercise or other potential issues such as metabolic problems or nutritional deficiencies ▪How sometimes a therapeutic relationship can feel like an arranged marriage ▪That a new model would only work if the intervention is early enough in the process, if we engage with people too late, it can be more difficult to help ▪How Dr. Singh remembers her first interaction with a patient and uses this to guide her in listening to the patients own wisdom and experience  ▪That Dr. Singh took some time to undertake a Leadership and Management fellowship and that this really helped her to stand back and appreciate the issues and to listen to the customer ▪That full disclosure and informed consent is so important ▪Functional medicine and how it differs to mainstream psychiatric approaches  ▪That functional medicine is a holistic approach that considers the whole person ▪and underlying root cause of chronic illness ▪In a functional approach there are no specialities ▪The place of recovery colleges in co-producing training in holistic ways of ▪maintaining health ▪That we still tend to think about contemplative practices as something to try rather than a core skill necessary for good mental health ▪That there is not enough evidence to influence a closed mind ▪That many of the best discoveries in medicine come from observation rather than from a laboratory ▪Dr Singh’s hope that psychiatry can return to a place of creativity and openness  To listen on Mad in America: https://goo.gl/tyyLmt Podcast show notes: https://goo.gl/zbxncn To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017

This week, we have an interview with Monica Cassani. Monica has seen the mental health system from both sides – as a social worker and as a person whose life was severely ruptured by psychiatric drugs. She writes critically about the system, as well as holistic pathways of healing without medication.  Monica’s website, Everything Matters Beyond Meds, is comprehensive library of information containing more than 5,000 blog posts, information articles, videos, personal experiences and shares many natural methods of self-care for finding and sustaining health in body, mind and spirit. Her blog also deals with wider issues in the socio/political and spiritual realms as they pertain to mental health and human rights issues surrounding psychiatry. I was keen to ask Monica about her own experiences of the psychiatric system, how a persons sensitivity can be affected by psychiatric treatment and how she helps and supports others to achieve health in body, mind and spirit. In this episode, we discuss: ▪How Monica came to be involved with the psychiatric system ▪How treatment was repeatedly forced on Monica ▪That the lack of information available meant that Monica felt she had no alternatives to the standard model of treatment ▪That she was threatened with committal to a State Asylum ▪How, because of the medications, Monica became non verbal and had difficulty walking ▪The betrayal that Monica felt after trusting and being failed by the medical system ▪How she has been drug free for more than 8 years after being on a substantial cocktail of five different medications for over 25 years ▪That Monica became focussed on getting past the drugs and on her work and took a harm reduction approach to getting off her medications ▪How Monica saw her withdrawal from the drugs as a rebellion and felt emancipated once she was medication free ▪That Monica witnessed clients struggling with the drugs and even, tragically, dying from their effects ▪How Monica views hypersensitivity and its relation to her healing ▪That Monica feels, in some ways, far healthier now than before the drugs but in other respects she feels that she struggles with things that others may find easy ▪That hypersensitivity seems to be common in those who have taken or withdrawn from psychiatric drugs ▪That most in the mental health system do not have the necessary experience to help those who have struggled with their medications ▪How Monica came to set up and invest time in her blog: Everything Matters Beyond Meds ▪How Monica was inspired by the work of the journalist Philip Dawdy and motivated by her family ▪How Everything Matters Beyond Meds combines science and holistic approaches in presenting options for people to support their health and wellbeing ▪That Monica takes a hands off approach to helping  and supporting others because she recognises the coercive nature of medical approaches and respects the right of the individual to choose for themselves ▪How people taking or withdrawing from psychiatric drugs tend to neglect their bodies and that preparation is important before tapering off medications ▪That diet is particularly important when considering withdrawing from psychiatric drugs To listen on Mad in America: https://goo.gl/tyyLmt Podcast show notes: https://goo.gl/oTo3g1 To get in touch with us email: podcasts@madinamerica.com © Mad in America 2017