19 votes

I have a massive gripe with reductive "politicization" of mental health

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12 comments

  1. r-tae
    Link
    I think your ending paragraph is massively unfair and unnecessary. It reads to me like you're saying that we should read his work with more skepticism than usual, because he had a medical...

    I think your ending paragraph is massively unfair and unnecessary.

    And last of all, this may be harsh but I think it needs saying, Mark Fisher fell victim to suicide. He's not exactly an epitome of healthy coping mechanisms, and his criticisms about mental health should be evaluated with that in mind.

    It reads to me like you're saying that we should read his work with more skepticism than usual, because he had a medical condition. Whether his line of thinking is correct or not, I don't see how personal experience with what he's talking about should make him a less reliable writer/thinker.

    20 votes
  2. [4]
    eggpl4nt
    Link
    I'm not sure I follow. When I saw a psychiatrist, she literally was just there to give me drugs to treat my symptoms of what society has deemed, according to the DSM, a mental illness. She didn't...

    it's not realistic to say psychiatry overlooks the social reasons for mental illnesses

    I'm not sure I follow. When I saw a psychiatrist, she literally was just there to give me drugs to treat my symptoms of what society has deemed, according to the DSM, a mental illness. She didn't care why I had those symptoms, she told me that's what I talk to my therapist about, and that she was just there to give me drugs to alter my brain enough so I don't have symptoms or that the symptoms are lessened.

    12 votes
    1. vord
      Link Parent
      My psychiatrist also does an hour of psychotherapy with the med check. He's a strong proponent of doing them both together, because otherwise things fall through the cracks.

      My psychiatrist also does an hour of psychotherapy with the med check.

      He's a strong proponent of doing them both together, because otherwise things fall through the cracks.

      11 votes
    2. DanBC
      (edited )
      Link Parent
      I feel like if she was overlooking the psycho-social stuff she would have said that talking therapy is pointless and told you not to bother with it. She was working within her competencies, with a...

      I feel like if she was overlooking the psycho-social stuff she would have said that talking therapy is pointless and told you not to bother with it. She was working within her competencies, with a multidisciplinary team.

      I wouldn't expect my psychiatrist to help me with housing, but I'm not sure that's the same as overlooking it.

      9 votes
    3. [2]
      Comment removed by site admin
      Link Parent
      1. sparksbet
        Link Parent
        I think there are arguments even for separate centers. I have ADHD and my psychiatrist mostly focuses on prescribing ADHD medication. His practice specializes in that, and he's good at his job....

        I think there are arguments even for separate centers. I have ADHD and my psychiatrist mostly focuses on prescribing ADHD medication. His practice specializes in that, and he's good at his job. But he'd be pretty useless at talk therapy about being trans and even at practical things relating to applying for medical treatments as a trans person, which is a huge part of what I currently see my current therapist for. And even if he could specialize in everything, my psychiatrist's office is CRAZY overbooked. Performing talk therapy for all patients in addition to psychiatric treatment would reduce their ability to give people access to the psychiatric care they need.

        3 votes
  3. [7]
    serafin
    Link
    I don't see how it does? It merely states in your highlighted section that there is higher risk. No more, no less. It doesn't exclude other potential risk factors from the picture, nor does it say...

    I think one of the other negative things about this argument is that, it denies the possibility that some people face mental illness not mainly as a result of social issues, but as a result of some biological unluck.

    I don't see how it does? It merely states in your highlighted section that there is higher risk. No more, no less. It doesn't exclude other potential risk factors from the picture, nor does it say anything about the distribution of risk.

    7 votes
    1. [6]
      DanBC
      (edited )
      Link Parent
      Some of the people pushing this point are very clear that mental illness does not exist. In the UK we have the Power Threat Meaning Framework written by prominent anti-psychiatry professionals....

      I don't see how it does?

      Some of the people pushing this point are very clear that mental illness does not exist. In the UK we have the Power Threat Meaning Framework written by prominent anti-psychiatry professionals. Lucy Johnstone is clear that bipolar disorder does not exist and that it is unethical to give people lithium to treat it. She's clear that schizophrenia does not exist, and that patients do not get benefit from anti-psychotic medications. She's clear that people have problems, those problems get given a biological label, but that those problems are entirely caused by responses to trauma.

      https://www.heraldscotland.com/news/17326328.mental-health-conditions-schizophrenia-even-depression-myth-according-leading-experts-mind/

      “THERE is no such thing as depression,” says Dr Lucy Johnstone. Johnstone is a clinical psychologist, trainer, speaker and writer, and a longstanding critic of biomedical model psychiatry. “There is no medical illness ‘depression’”, she elaborates. “Neither are there conditions such as schizophrenia, or psychosis. Telling people they have borderline personality disorder is unethical, unscientific, unprofessional, inexcusable.

      “Biomedical clinical psychiatry is an ideology and it is wrong for professionals to impose this on people.”

      It's important to remember that these extremist views are held by a minority of professionals, and that most MH professionals in the UK (as opposed to academics) are strong believers in a bio-psycho-social model, and recognise the importance of robust well functioning multi disciplinary teams to address a range of factors that affect people's lives.

      EDIT: there's a calm and measured response to PTMF here: https://www.nationalelfservice.net/mental-health/power-threat-meaning-framework-innovative-and-important-ptmframework/

      9 votes
      1. [5]
        eggpl4nt
        Link Parent
        I think people who do not want to take psychiatric drugs, which are not without their risks and side effects, should be free to use a framework like the PTMF. PTMF does not box people into DSM...

        I think people who do not want to take psychiatric drugs, which are not without their risks and side effects, should be free to use a framework like the PTMF. PTMF does not box people into DSM labels, some of which are highly stigmatized like schizophrenia and bipolar disorder, which can be distressing to people and make their mental health even worse.

        It is possible for a person to work with the symptoms that create the DSM labels schizophrenia and bipolar disorder without psychiatric medication and the need to deem a person as having a lifelong "incurable mental illness." For example, Eleanor Longden who successfully manages the voices in her head and has gone on to earn a master's in psychology and do TED talks on mental health.

        At the same time, if someone finds their psychiatric medication beneficial to them, they are free to take it. I just understand the creators of PTMF concerns about the current state of an overly-heavy reliance on just psychiatric medications while ignoring emotional and social impacts to a person's mental health.

        3 votes
        1. [4]
          DanBC
          Link Parent
          No, you don't. The PTMF authors think you are irresponsible and unethical because you've said that some people may get benefit from psychiatric meds and should be able to continue taking them.

          I just understand the creators of PTMF concerns about the current state of an overly-heavy reliance on just psychiatric medications while ignoring emotional and social impacts to a person's mental health.

          No, you don't. The PTMF authors think you are irresponsible and unethical because you've said that some people may get benefit from psychiatric meds and should be able to continue taking them.

          3 votes
          1. [3]
            eggpl4nt
            Link Parent
            That sounds like massive exaggeration and disingenuous. Here is an excerpt from Lucy Johnstone herself about the PTMF from this article where she explicitly states psychiatric drugs can be used:...

            That sounds like massive exaggeration and disingenuous. Here is an excerpt from Lucy Johnstone herself about the PTMF from this article where she explicitly states psychiatric drugs can be used:

            Our aim was to offer a new, non-medical perspective on why people sometimes struggle with a whole range of overwhelming emotions and experiences such as confusion, fear, despair, hopelessness, mood swings, hearing voices, self-harming, panic, eating difficulties, and so on. The PTMF argues that distress of all kinds, even the most severe, is understandable in the context of our relationships and social circumstances, and the wider structures, norms and expectations of the society and culture we live in.

            Changing the narrative from ‘I have a mental illness/mental health problem’ to ‘I am surviving difficult circumstances in the best way I can’ is an essential step towards helping us find new ways forward. This may include various forms of therapy or social support, as offered by the best current services. It might include some use of psychiatric drugs to manage overwhelming feelings, as long as we do not see them as ‘treating medical illnesses’ or resolving life problems.

            For anyone interested in learning more, the British Psychological Society has a lot of information and documents about PTMF.

            1 vote
            1. [2]
              DanBC
              Link Parent
              I've spent the past 5 years talking to these people, both on and off line, and their position is crystal clear. This is the quality of research being used to promote PTMF:...

              I've spent the past 5 years talking to these people, both on and off line, and their position is crystal clear.

              This is the quality of research being used to promote PTMF: https://retractionwatch.com/2022/10/20/what-happened-when-a-psychology-professor-used-a-peer-reviewed-paper-to-praise-his-own-blog-and-slam-others/

              They say in the PTMF that psych meds can be used, but with informed consent. You need to understand what they mean by "Informed" - they've said that we need to tell patients that meds do not work and that meds cause harm. If you tell someone that eg bipolar doesn't exist, that lithium does not work and that lithium causes harm is your aim to support that person to take the meds or is your aim to prevent that person from taking the meds?

              At the same time as affirming people’s right to describe their difficulties as they wish, we
              affirm the equally important principle that professionals, researchers, trainers, lecturers,
              charities, policy-makers and others involved in the mental health field should use language
              and concepts that have some claim to be descriptively accurate and evidence-based.
              Because psychiatric diagnosis does not meet these standards, it follows that it can no longer
              be considered professionally, scientifically or ethically justifiable to present psychiatric
              diagnoses as if they were valid statements about people and their difficulties.

              They don't want doctors to diagnose bipolar because that would mean medication for bipolar becomes available. Without the dx medication is not available, because this is how licencing works.

              Also from the PTMF

              Informed choice depends on receiving comprehensive and accurate information in
              the first place, and the mode of action of psychiatric drugs needs to be understood
              and explained differently. The PTM Framework is consistent with psychiatrist Joanna
              Moncrieff’s contrasting descriptions of the ‘disease-centred’ and the ‘drug-centred’ models
              of drug action. Medication development and use in general medicine often aims to
              reverse, partially reverse or compensate for, the assumed biological causes of disease and
              bodily symptoms (e.g. replacing the body’s insulin supply, destroying cancerous tumours,
              killing bacteria, and so on). This ‘disease-centred’ model, while not always applicable in
              medical practice, does not apply at all within psychiatric practice because the diagnostic
              clusters give us no information about biological causes. Rather, the action of psychiatric
              drugs conforms to the ‘drug centred’ model, in that they have a range of general effects
              such as sedation or emotional blunting on both ‘normal’ and ‘abnormal’ states of mind
              (Moncrieff, 2008). In fact, claims that the drugs correct ‘chemical imbalances’ are rapidly
              being retracted by senior figures in the field (Pies, 2014). A more accurate analogy is
              drinking alcohol as a relief for anxiety in social situations, rather than, say, insulin to
              restore a physiological deficit. The PTM Framework suggests another analogy: intense
              grief after the death of a partner may be greatly relieved by short-term use of medication
              to aid sleep, but we would not describe this as ‘treatment’ for a ‘disease’. Neither the PTM
              Framework nor the drug-centred model of action justify telling people that psychiatric
              drugs are essential to prevent or treat ‘illness’, or pressurising or coercing them into taking
              them against their will.

              The drug-centred model acknowledges that the abnormal brain states induced by
              psychiatric drugs may be experienced as helpful by some people in some circumstances.
              Some service users have described being better able to cope with overwhelming anxiety
              or hostile voices. Others have described a difficult trade-off between beneficial and
              unpleasant effects (Carrick et al., 2004). Many have testified to unbearable feelings of
              emptiness, dread and agitation which may be worse than the difficulties for which the
              drugs were prescribed (Moncrieff et al., 2009). The problem is that although psychiatric
              drugs may help to control feelings and behaviour, this comes at a price, because they
              also block the systems that regulate engagement, motivation, pain, and pleasure (van
              der Kolk, 2014, p.225–227). Similarly, while these drugs can sometimes enable access to
              therapy or be of help in the initial stabilisation stage, they can also hinder longer-term
              therapeutic work by cutting off access to emotions and impairing motivation. Van der Kolk
              (2014) summarises the pros and cons of different classes of psychiatric drugs in working
              with people who have experienced adversities and traumatic events, and recommends a
              careful negotiation to determine what might be most helpful in particular situations. The
              principles of drug-centred prescribing are outlined in Yeomans et al. (2015).
              Further implications of drug use within a PTM Framework are:
              ●● Misleading terms like ‘antipsychotics’, ‘anti-depressants’ and ‘mood stabilisers’ should
              be abandoned since they do not describe the mode of action, and help to set the scene
              for automatic prescription in response to certain difficulties.
              ●● Professionals urgently need up-to-date information about the emerging evidence of
              limitations and harms potentially caused by all classes of psychiatric drugs, and to
              receive training on the use of medication within a drug-centred model. This applies not
              only to psychiatrists, GPs and psychiatric nurses, but, as suggested in the 2008 NIMHE
              report ‘Medicines management: Everybody’s business’, to all professionals who work in
              settings where psychiatric medication is used. Any of these people may be inadvertently
              giving inaccurate messages or failing to challenge poor practice (NIMHE, 2008).
              ●● Psychiatric drugs should be prescribed on the basis of fully informed choice, with
              service users as equal partners in the decisions (Deegan, 2007, 2010).
              ●● Support to come off psychiatric drugs needs to be routinely available within mental health
              services, through information leaflets, professional advice, support groups and so on.
              ●● Particular disquiet have been expressed about psychiatric drug use in Intellectual
              Disabilities to sedate, manage and control people (Public Health England, 2015).
              Similarly, the misuse and overuse of neuroleptics in Older Adults with dementia for the
              control of behaviour has been the subject of a Department of Health report (Bannerjee,
              2009). In both these relatively less powerful populations, prescribing is common even in
              the absence of any psychiatric diagnosis, existing cognitive impairments are likely to be
              exacerbated, and lives may be shortened. This is a matter of urgent concern.
              Adoption of these principles would be likely to lead to substantial reduction, and hence
              cost savings, in the use of psychiatric drugs, whether prescribed by GPs or psychiatrists.
              Even greater savings can be envisaged in the future, given the growing amount of
              evidence that all classes of psychiatric drugs may be less effective than has been assumed
              (e.g. Bentall, 2009; Kirsch, 2009; Moncrieff, 2015) and may actually increase disability
              over the long term (Viola & Moncrieff, 2016; Whitaker, 2010) up to and including brain
              degeneration and early death (Hutton et al., 2014). There is a curious reluctance to

              This last point, about people with LD is telling. We have the programme STOMP (Stop Over Medicating People with Learning Disability). It's right to mention this, LeDeR reviews tell us that over-medicalisation in this group causes severe harm. But that programme is joined with STAMP (Supporting Treatment and Appropriate Medication in Paediatrics). Why mention the programme that seeks to reduce medication but not the one that seeks to increase appropriate medication?

              These people are all active on social media, go ask Moncreiff, Bentall, Double, Kinderman, Johnson etc about their views.

              1. eggpl4nt
                Link Parent
                I don't disagree with basically anything quoted. I am not going to be convinced to revoke my support of PTMF, because it likely was a major turning point that allowed me to care about myself again...

                I don't disagree with basically anything quoted. I am not going to be convinced to revoke my support of PTMF, because it likely was a major turning point that allowed me to care about myself again and appreciate life.

                We likely have a massive disagreement on this and I am not going to back down from being grateful that the PTMF exists, because I helped me feel immensely better knowing it existed at a time when I was mentally at my worst. Because I have been personally affected by a careless psychiatric system in the United States. I was not given informed consent about psychiatric medications a psychiatrist at an inpatient clinic I was stuck in for a week coerced me to take, even though I did not want to take psychiatric drugs. He did not inform me of the side effects of the drug he wanted me to take, the side effects of the medication were very much brushed off. I was not even offered a chance to allow myself to heal my emotional problems without psychiatric medications. After I was released from the intake, I felt even worse than when I was admitted. I felt absolutely violated. I actually gained more trauma from the careless dismissive treatment I experienced in the psychiatric hospital, and I now have to work with a trauma therapist to work through the trauma that landed me in the psychiatric hospital in addition to the trauma I developed because of having to stay in a psychiatric hospital for a week. It has been over a year and I still have nightmares about the psychiatric hospital. I had to take a break from reading comments in my "The Lame Racehorse" post because someone recommended checking into a mental health inpatient facility which I guess, somewhat embarrassingly, "triggered" me into breaking down crying due to a flood of memories about what I had experienced at the psychiatric hospital and the months of severe depression that followed.

                I felt even more suicidal after my stay at an inpatient psychiatry wing of a hospital than before when I initially was placed there. I felt subhuman. I felt like a disease label. Finding out about PMTF was like having someone look right at me with genuine care in their eyes and say "you went through a lot, what you went through was difficult, it's going to be okay, you're still a whole human being," instead of the dismissive "you're a sick and broken person, a disgusting mental leper" attitude modern psychiatry coldly gave me while throwing a psychiatric drug prescription at my face.

                I have never mentioned this on my "main" social media account because I have felt so hurt and ashamed and violated and embarrassed and scared about what happened to me and how modern psychiatry treated me. And I know that people still stigmatize those who struggle with mental health issues and sometimes treat us like we "don't know better." But I guess I am going to be brave enough to say this surface-level version of what happened to me now, for this post, because I suppose I cannot stand to see someone dragging something that made me feel human again through the mud.

                I am immensely grateful that PTMF exists. If you don't like it, don't use it. It's not like it's some extremely popular framework that's being pushed through the medical field at record speeds. PTMF could greatly reduce profits for the psychiatric/pharmaceutical industry, so it's not going to be popular in profit-driven capitalist countries, especially the United States. People should be free to find alternative ways to treat their mental health that resonate with them and help them heal like PTMF did with me.

                2 votes