Sunday, 6 January 2013

strength and resilience, madness and insight

I'd come upon this interesting 2 part interview from 2011 with Robert Whitaker in 'Behavioural Healthcare', on the topic of 'Transforming our thinking about psychiatric medications'.  Interviewers Lori Ashcraft and Bill Anthony.

Part One, July 2011

Part Two, October 2011

The introduction, likening the Wizard of Oz story and Toto pulling back the curtain, to the somehow unmasking of psychiatric drugs, drew me in to the piece.  And I've been thinking on the answer from Bob Whitaker, in Part Two, page 3, to Lori's comment about maybe becoming stronger if she hadn't had to take psychiatric medications for 30yrs:

"I think that is a very important point. We have been conditioned today to think that when you are feeling emotional pain or psychiatric distress, then that may be a symptom of a mental disorder, and you can take this pill to squash that symptom. But there is evidence that if people can struggle through an initial bout of depression or other form of psychiatric distress without going on medication, they can come out stronger on the other side.

But clearly that can be hard and it can be painful, and at least in certain situations, it can be risky to forgo the medications. If a person decides to forgo the medications, then it would be nice if he or she could get other psychosocial support."

The challenge nowadays is to be able to access psychosocial support for mental distress when the first recourse is to pop a pill to make it go away.  For physical pain this can work, pain that is occasional and not to do with major issues, as in paracetamol or ibuprofen for a headache or flu.  The problem with psychiatric pills for mental distress is that the treatment can be worse than the cure.

And for those of us who are find ourselves in an alternative universe, an escape from the trauma or stress, nowadays called psychosis, used to be called nervous breakdown, then it is a harsh bringing back to reality with brain altering chemicals.  Dictated by doctors under the mental health act, otherwise known as compulsory treatment.  Depending on the skill of the practising psychiatric nurse as to whether this is forced or persuaded.

I really don't like the psychiatric drugs so wouldn't want to swallow them if I could help it.  They make me dependent and vulnerable, unlike myself and lacking in decision-making abilities.  And take me considerable inner strength and resilience to get off them.  By taking charge of my own mental health, defying the labels and prognosis, and recovering.

Therefore I think this inner strength and resilience has to be a positive thing, even when psychiatrists and psychiatry don't seem to like it and do everything they can to squash it.  Or that was my experience.  Even yet I get psychiatrists trying to tell me what to do, what to say, what not to say etc.  It's very irritating.  You know who you are.  Even recently I had to tell one that I was 60, not a teenager, and knew what I was doing in my blog writing.

There's something in psychiatry that won't let go of the patient, even when they are getting better and have insight.  Almost like they could be out of a job if all their patients recover.  Yes that's the point of it all, in my opinion.  Getting better, recovering.  Has anyone told the psychiatrists?  That there is a time to let go and let live.  And people can have insight in the midst of their psychotic experience.  Maybe not the same insight as the psychiatrist.  But some would say the psychiatrist has left their insight at the door of the psychiatric hospital, on the way in.

I'm being cheeky and provoking.  It's needed, especially in the topsy turvy world of psychiatry.  Where it's difficult to tell the mad people from the others, except for their badges, uniforms and suits.  Otherwise we just wouldn't know, would we?  I remember a time when the psychiatric nurses weren't in uniform and if I didn't see their badge well I really wasn't sure who was a patient.  It wasn't obvious.  And nowadays the uniformed ones are the maddest, in my opinion.  They must be to do what they do.

I hear from other carers who say that the person they care for doesn't believe they are mentally ill, don't have schizophrenia etc.  I reply that's good, it shows they have insight.  But I'm in the minority because the carers who aren't survivors don't usually have the same opinion as me.  They probably think I'm mad and lack insight too.  We agree to differ.  It's a matter of having been there, done that, wore the tee-shirt sort of a thing.

Until you've been a psychiatric patient, labelled and forcibly drugged then you won't really know what it's like.  It can't be imagined.  Same as having a baby, what that feels like.  Or, for me, what having an alcohol or drug addiction feels like, which I can't imagine.  I've never liked alcohol or been tempted by recreational drugs.  So why would I have an opinion on resisting them if addicted to them?  

But I do have strong opinions about psychiatry and the need for alternative treatments.  Also ways of encouraging inner strength and resilience in children and young people, in adults too.  So that they can be self governing, self aware, self confident, while also being responsible citizens and balanced individuals.  A life worth living, for all of us, including when our mental health is being challenged.


  1. Psychiatrists, for the most part, won't let go because they are the victims of their own delusions of the "clinical gaze." Psychiatry breeds learned helplessness, the very opposite of what it takes to heal

  2. Thanks for commenting Jasenn. Interesting points about the clinical gaze and learned helplessness. Neither of which impressed me over the years. I noticed, in your writing, that you link clinical psychology with psychiatry in this agency and I agree. For some time now I've thought that psychology sits on the fence, waiting, for who knows what. Maybe until the wind changes.

  3. Chrys, I put here a link if that's OK.

    Drugs aren't more efficient than therapy ( BCT or other kind) in preventing psychosis.However drugs have much more nasty side effects!
    My daughter is 32 and she surely knows who she is. She tried to get herself some therapy paying privately ( she isn't well-off). And the privately paid psychiatrist frightened her telling her that if she stops taking the meds she risks becoming drugs resistant ( ? ) and having ECT in future. Fortunately she is not the one to be bullied easily.
    Zofia, Dunfermline

  4. Thanks Zofia. It doesn't sound like a helpful thing for the therapist to say.

  5. you are so right when you say that psychiatrists don't know when to let go. My son kept telling them: "I am fine, please leave me alone now" but they just wouldn't. They insisted on checking on him.He wasn't taking medication-hadn't been taking any for 2 years. "He was bound to have another break down any time soon" they insisted. They meant well, so he tried to be polite. At the end he just ran to regain his freedom but of course on his medical notes he is supposed to be suffering from severe mental illness. He gives every doctor a wide berth.

  6. Anonymous thanks for commenting.

    Medical notes, I have found, can be a work of fiction. And some of us want to live without being on psychiatric drugs and can do so well enough. I managed it and was prepared to take the responsibility. And anyway, how do you know if you need them until you are off them?

    I don't like chemical substances, alcohol or anything to alter my mind. I prefer to be clear headed if possible. And to think things through.

  7. I think some clinical psychologists sit on the fence because it is hard to challenge the dominant medical discourse in which we are forced to work in the NHS. However as a trainee clinical psychologist I'd like to think the majority of us do not turn a blind eye to the many injustices of psychiatric care. I certainly do not intend to ever sit on the fence.