Mad in America: Rethinking Mental Health

Morgan Shields is one of the few health policy researchers who focuses on quality of care and issues of coercion within inpatient psychiatry. Her research exposes how current healthcare settings are influenced by power imbalances, profit structures, and organizational priorities that are fundamentally misaligned with the human needs of individual patients. Dr. Shields completed her Ph.D. in Social Policy at Brandeis University and is currently an Assistant Professor at the Brown School of Social Work at Washington University in St. Louis, where she also directs her own research group. She has published over 25 peer-reviewed articles in outlets such as Health Affairs, Psychiatric Services, and the JAMA Network. She has also completed several policy reports for entities such as the U.S. Health and Human Services Office, and has served as a legal expert in cases related to psychiatric patient discrimination. In doing so, her research has effected change at the state and federal levels, prompting internal investigations and structural reforms within agencies such as the Veterans Health Administration and the Massachusetts Department of Mental Health. In this interview, Dr. Shields discusses her current work, which aims to identify strategies for implementing patient-centered and equitable treatment within existing mental health care structures—toward a wholesale re-imagining of inpatient psychiatry.

This week we are sharing a special interview that's being done as part of World Tapering Day. World Tapering Day is being held on the 4th, 5th and 6th of November 2022 and it aims to raise global awareness of the need to safely taper psychotropic drugs. It has been organized by people with personal experience of the severe difficulties that can arise when stopping antidepressants, antipsychotics or benzodiazepines. If you would like to find out more or participate, you can visit the website WorldTaperingDay.org where you can sign up for a range of free-to-view webinars. Our guest today is Anders Sørenson. Anders is a Danish clinical psychologist with a special interest in psychiatric drug withdrawal. He has undertaken research which assesses the state of guidance on psychiatric drug withdrawal. He has also paid close attention to tapering methods with the aim of identifying approaches which might make withdrawal more tolerable for people. In addition to his research work, Anders utilizes psychotherapy in his private practice when helping people to come off the drugs and we'll get to talk about some of that in this interview.

Justin Karter is a staff psychologist at Boston College University Counseling Services. He is a recent graduate of the doctoral program in Counseling Psychology at the University of Massachusetts Boston, where he completed his dissertation research on the experiences of psychosocial disability activists in the Global South. He has served as the editor of the research news section of the Mad in America website since 2015. In addition, he has held executive board positions with the Society for Humanistic Psychology and the Society for Theoretical and Philosophical Psychology. Despite being a recent graduate and early career psychologist, he has published over 25 papers and textbook chapters on topics in critical psychology, critical psychiatry, and philosophy of psychology. While he has often been the interviewer for our MIA podcasts, today, we get to turn the mic around and ask him some questions. In doing so, we discuss his journey into the field and what he has learned through his work with MIA, research in critical psychiatry and psychology, and his practice as a therapist.

This week on the Mad in America podcast, we are joined by activist and artist Jim Flannery. Born and raised in suburban Weathersfield, Connecticut, Jim was committed at four mental hospitals across the United States. There he received the best care available in the modern world… torture, which included seclusion, restraints, forced drugging, coercion, and a psychiatric diagnosis. Later, he turned to the arts to speak out publicly about his experiences with the mental health system through performing stand-up comedy under the pseudonym Flim Jannery and now through music with his new album, "Sorry, It's Not Funny," which will be released on Friday, October 14. In 2020, Jim began hearing voices, which opened his eyes to what he terms a genocide against neurodiverse people. He shifted his creative efforts towards hip-hop, believing the genre was the best medium to communicate his perspective. You can hear the new album on the website jim-flannery.com. It's also on Spotify, Apple Music, YouTube, Pandora, SoundCloud, and Tidal.

Dr. Diana Rose wears many hats—academic, researcher, service user, and activist. She is a leading figure in user-led research and currently an Honorary Distinguished Professor at the Australian National University. Dr. Rose was previously Professor of User Led Research and Director of the Service User Research Enterprise (SURE) at King's College. She was also lead in Patient and Public Involvement in several large research programmes at the Institute of Psychiatry, Psychology, and Neuroscience. Apart from an impressive set of publications, Dr. Rose's new book Mad Knowledges and User-Led Research is about to hit the markets. In today's interview, she brings together her vast breadth of experience and depth of knowledge to talk about the challenges service users and survivors of psychiatry face when they take space as knowers and researchers in the Psy-disciplines. *** If you find this podcast valuable, rating it and leaving a review on iTunes or Spotify or sharing it on social media helps us to get the word out about these important conversations. Thank you.

This week on the Mad in America podcast, we are joined by Dr. Jon Jureidini. Jon is a child psychiatrist who also trained in philosophy, critical appraisal and psychotherapy. He has a continuing appointment as a professor in the School of Medicine at the University of Adelaide. He heads Adelaide University's Critical and Ethical Mental Health research group, which conducts research, teaching and advocacy to promote safer, more effective and more ethical research and practice in mental health; and the Paediatric Mental Health Training Unit, providing training and support to medical students, GPs, allied health professionals, teachers and counsellors in non-pathologising approaches to primary care mental health. He has an international reputation for his work on the evidence base for psychiatry and is a strong advocate for addressing the social determinants of mental health. Jon, together with co-author Leemon B. McHenry, wrote the book The Illusion of Evidence-Based Medicine published in 2020. The book was followed by an opinion piece which appeared in the British Medical Journal in March 2022. In this interview, we discuss the issues with evidence-based medicine and what led to the debasement of a system originally conceived to challenge extravagant claims and poor science.

This week on the Mad in America podcast, we are really pleased to be announcing the launch of a new global affiliated site: Mad in Ireland. Mad in Ireland launches on August the 22nd and joins our other global sites which include Mad in the UK, Mad in Canada, Mad in Finland and Mad in Brasil amongst others. Joining me to discuss the launch and the important role that Mad in Ireland will play are Liam MacGabhann, Martha Griffin, Elaine Browne and Harry Gijbels who are part of the team that has been working hard to get the new site up and running. You can visit Mad in Ireland from August 22nd here: https://madinireland.com Please help them get up and running by visitng the site and sharing it on social media. Thank you.

Our guest today is Beverley Thomson. Beverley is a writer, researcher and speaker with a focus on psychiatric medication including antidepressants, benzodiazepines and ADHD drugs. She is interested in their history, how the drugs work, adverse effects, dependence, withdrawal and development of patient support services. For the past 10 years, she has worked with organizations such as the British Medical Association, the Scottish Government and recently the UK All Party Parliamentary Group (APPPG) for prescribed drug dependence. She is currently part of a Scottish Government Short Life Working Group addressing the issue of prescribed drug harm and dependence in Scotland. We talk about Beverley's latest book, entitled Antidepressed: A Breakthrough Examination of Epidemic Antidepressant Harm and Dependence published by Hatherleigh Press in 2022. Featuring compelling accounts from people whose lives have been irrevocably harmed by prescribed antidepressants, Beverley's work provides proof that there is no such thing as a magic pill and that pretending otherwise risks the lives and well-being of those who need help the most. *** If you find this podcast valuable, rating it 5 stars and leaving a review on iTunes or Spotify or sharing it on social media helps us to get the word out about these important conversations. Thank you.

On the Mad in America podcast this week, we hear from the co-authors of a paper published in the journal Ethical Human Psychology and Psychiatry which documents the mass murder of a quarter of a million people, mostly diagnosed as "schizophrenic" in Europe during the Second World War. Later, we hear from Dr. Jeffrey Masson, who is an author and a scholar of Sanskrit and psychoanalysis. But first, we talk with professor of psychology John Read. Regular visitors to Mad in America will know of John's work. For those that don't know, John 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, in 1994, 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 currently works in the School of Psychology at the University of East London. John has many research interests, including critical appraisals of the use of psychiatric drugs and electroconvulsive therapy. Jeffrey Masson has had a fascinating career in which he studied Sanskrit and psychoanalysis and became director of the Sigmund Freud archives. A prolific author, he has written more than 30 books and has become an advocate for animal rights. He is currently an Honorary Fellow in the Department of Philosophy at the University of Auckland in New Zealand. We discuss how John and Jeffrey came to write a paper which examines a grim period in psychiatric history.

In March 2022, a new grief-related disorder was officially adopted into mainstream mental health diagnosis nomenclature. Prolonged Grief Disorder (PGD) is a recent addition to the Diagnostic and Statistical Manual fifth edition text revision (DSM-5-TR). A PGD diagnosis is to be used when a person is grieving too long and too intensely. In this interview, Kaori Wada, Psychologist, grief researcher, and Associate Professor and Director of Training at the University of Calgary, builds upon her recent paper on the Medicalization of Grief in conversation with MIA Science News Writer and Psychologist Zenobia Morrill. Wada articulates a history of institutional tensions and financial conflicts behind the creation of this new PGD diagnosis. She also discusses the ways PGD could shape how we collectively understand and respond to those grieving. Wada's work demonstrates that the creation of PGD was not based on scientific findings but appears to be entangled in long-standing arguments between camps of mental health professionals with different stakes in whether the diagnosis became legitimized. Further, PGD, as with other diagnoses, represents elements of mainstream psychological theory that tend to render deviations from Western cultural norms as "unhealthy." Is diagnosis needed to provide support and care? If so, those most likely to experience marginalization, violence, and unjust loss are also most likely to be classified as having PGD, a mental illness. At a time when the world is fraught with tragic loss—owing to causes ranging from political failures, state violence, and the COVID-19 pandemic—grieving has been transformed into a mental health disorder. But the complicated question of what a mental disorder is continues to be glossed over. The opportunity for psychiatric professionals to embrace humility seems to have reverted to the familiar "diagnose-and-treat" response. Will pharmacological intervention become the dominant "treat" response to a diagnosis of PGD? A new grief disorder is a clear departure, however, from the way grief used to be described in the field as an example of something that is clearly not a mental health disorder, Wada shared. She exclaims: "To me, the medicalization of grief is controversial because it may fundamentally shake up the concept of a mental disorder, [how it has] been defined and understood." Wada and Morrill explore what this new PGD diagnosis may mean, reflecting on the ways the "diagnose-and-treat" logic seems to of experiences formerly considered part of the territory of being human. The need to pathologize experiences in order to address them represents a paradox. A new ethical and moral quandary befalls professionals tasked with determining when grief is an illness and when expressions of grief are inappropriate. Will the public embrace this new disorder? Will the medicalization of grief be resisted? Will a pandemic of PGD diagnoses follow a global pandemic? Wada speaks to the personal and professional influences that shaped these curiosities and her approach to researching how grief is being construed in the mental health field.