Category: Mental Health

An Overview of the Critical Psychiatry Network

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Introduction

The Critical Psychiatry Network (CPN) is a psychiatric organisation based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the Mental Health Act 1983. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom’s National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.

Participants in the Critical Psychiatry Network share concerns about psychiatric practice where and when it is heavily dependent upon diagnostic classification and the use of psychopharmacology. These concerns reflect their recognition of poor construct validity amongst psychiatric diagnoses and scepticism about the efficacy of anti-depressants, mood stabilisers and anti-psychotic agents. According to them, these concerns have ramifications in the area of the use of psychiatric diagnosis to justify civil detention and the role of scientific knowledge in psychiatry, and an interest in promoting the study of interpersonal phenomena such as relationship, meaning and narrative in pursuit of better understanding and improved treatment.

CPN has similarities and contrasts with earlier criticisms of conventional psychiatric practice, for example those associated with David Cooper, R.D. Laing and Thomas Szasz. Features of CPN are pragmatism and full acknowledgment of the suffering commonly associated with mental health difficulties. As a result, it functions primarily as a forum within which practitioners can share experiences of practice, and provide support and encouragement in developing improvements in mainstream NHS practice where most participants are employed.

CPN maintains close links with service user or survivor led organisations such as the Hearing Voices Network, Intervoice and the Soteria Network, and with like-minded psychiatrists in other countries. It maintains its own website. The network is open to any sympathetic psychiatrist, and members meet in person, in the UK, twice a year. It is primarily intended for psychiatrists and psychiatric trainees and full participation is not available to other groups.

Coercion and Social Control

The other involved the introduction of community treatment orders (CTOs) to make it possible to treat people against their wishes in the community. CPN submitted evidence to the Scoping Group set up by the government under Professor Genevra Richardson. This set out ethical and practical objections to CTOs, and ethical and human rights objections to the idea of reviewable detention. It was also critical of the concept of personality disorder as a diagnosis in psychiatry. In addition, CPN’s evidence called for the use of advance statements, crisis cards and a statutory right to independent advocacy as ways of helping to sustain autonomy at times of crisis. CPN also responded to government consultation on the proposed amendment, and the white paper.

The concern about these proposals caused a number of organisations to come together under the umbrella of the Mental Health Alliance to campaign in support of the protection of patients’ and carers’ rights, and to minimise coercion. CPN joined the Alliance’s campaign, but resigned in 2005 when it became clear that the Alliance would accept those aspects of the House of Commons Scrutiny Committee’s report that would result in the introduction of CTOs. Psychiatrists not identified with CPN shared the Network’s concern about the more coercive aspects of the government’s proposals, so CPN carried out a questionnaire survey of over two and a half thousand (2,500) consultant psychiatrists working in England seeking their views of the proposed changes. The responses (a response rate of 46%) indicated widespread concern in the profession about reviewable detention and CTOs.

The CPN was paid attention by Thomas Szasz who wrote: “Members of the CPN, like their American counterparts, criticise the proliferation of psychiatric diagnoses and ‘excessive’ use of psychotropic drugs, but embrace psychiatric coercions.”

The Role of Scientific Knowledge in Psychiatry

There is a strong view by CPN that contemporary psychiatry relies too much on the medical model, and attaches too much importance to a narrow biomedical view of diagnosis. This can, in part, be understood as the response of an earlier generation of psychiatrists to the challenge of what has been called ‘anti-psychiatry’. Psychiatrists such as David Cooper, R.D. Laing and Thomas Szasz (although the latter two rejected the term) were identified as part of a movement against psychiatry in the 1960s and 1970s. Stung by these attacks, as well as accusations that in any case psychiatrists could not even agree who was and who was not mentally ill, academic psychiatrists responded by stressing the biological and scientific basis of psychiatry through strenuous efforts to improve the reliability of psychiatric diagnosis based in a return to the traditions of one of the founding fathers of the profession, Emil Kraepelin.

The use of standardised diagnostic criteria and checklists may have improved the reliability of psychiatric diagnosis, but the problem of its validity remains. The investment of huge sums of money in Britain, America and Europe over the last half-century has failed to reveal a single, replicable difference between a person with a diagnosis of schizophrenia and someone who does not have the diagnosis. The case for the biological basis of common psychiatric disorders such as depression has also been greatly over-stated. This has a number of consequences:

First, the aggrandisement of biological research creates a false impression both inside and outside the profession of the credibility of the evidence used to justify drug treatments for disorders such as depression and schizophrenia. Reading clinical practice guidelines for the treatment of depression, for example, such as that produced for the UK National Health Service by the National Institute for Health and Clinical Excellence (NICE), one might be fooled into believing that the evidence for the efficacy of selective serotonin reuptake inhibitors (SSRIs) is established beyond question. In reality this is not the case, as re-examinations of drug trial data in meta-analyses, especially where unpublished data are included (publication bias means that researchers and drug companies do not publish negative findings for obvious commercial reasons), have revealed that most of the benefits seen in active treatment groups are also seen in the placebo groups.

As far as schizophrenia is concerned, neuroleptic drugs may have some short-term effects, but it is not the case that these drugs possess specific ‘anti-psychotic’ properties, and it is impossible to assess whether or not they confer advantages in long-term management of psychoses because of the severe disturbances that occur when people on long-term active treatment are withdrawn to placebos. These disturbances are traditionally interpreted as a ‘relapse’ of schizophrenia when in fact there are several possible interpretations for the phenomenon.

Another consequence of the domination of psychiatry by biological science is that the importance of contexts in understanding distress and madness is played down. This has a number of consequences. First, it obscures the true nature of what in fact are extremely complex problems. For example, if we consider depression to be a biological disorder remediable through the use of antidepressant tablets, then we may be excused from having to delve into the tragic circumstances that so often lie at the heart the experience. This is so in adults and children.

Meaning and Experience in Psychiatry

There is a common theme, here, with the work of David Ingleby whose chapter in Critical Psychiatry: The Politics of Mental Health sets out a detailed critique of positivism (the view that epistemology, or knowledge about the world is best served by empiricism and the scientific method rather than metaphysics). A common theme running through Laingian antipsychiatry, Ingleby’s critical psychiatry, contemporary critical psychiatry and postpsychiatry is the view that social, political and cultural realities play a vital role in helping us to understand the suffering and experience of madness. Like Laing, Ingleby stressed the importance of hermeneutics and interpretation in inquiries about the meaning of experience in psychiatry, and (like Laing) he drew on psychoanalysis as an interpretative aid, but his work was also heavily influenced by the critical theory of the Frankfurt School.

The most forceful critic of this view was R.D. Laing, who famously attacked the approach enshrined by Jaspers’ and Kraepelin’s work in chapter two of The Divided Self, proposing instead an existential-phenomenological basis for understanding psychosis. Laing always insisted that schizophrenia is more understandable than is commonly supposed. Mainstream psychiatry has never accepted Laing’s ideas, but many in CPN regard The Divided Self as central to twentieth century psychiatry. Laing’s influence continued in America through the work of the late Loren Mosher, who worked at the Tavistock Clinic in the mid-1960s, when he also spent time in Kingsley Hall witnessing Laing’s work. Shortly after his return to the US, Loren Mosher was appointed Director of Schizophrenia Research at the National Institute of Mental Health, and also the founding editor of the journal Schizophrenia Bulletin.

One of his most notable contributions to this area was setting up and evaluating the first Soteria House, an environment modelled on Kingsley Hall in which people experiencing acute psychoses could be helped with minimal drug use and a form of interpersonal phenomenology influenced by Heidegger. He also conducted evaluation studies of the effectiveness of Soteria. A recent systematic review of the Soteria model found that it achieved as good, and in some areas, better, clinical outcomes with much lower levels of medication (Soteria House was not anti-medication) than conventional approaches to drug treatment.

Efficacy

One comparison study showed 34% of patients of a ‘medical model’ team were still being treated after two years, compared with only 9% of patients of a team using a ‘non-diagnostic’ approach (less medication, little diagnosis, individual treatment plans tailored to the person’s unique needs). However the study comments that cases may have left the system in the ‘non-diagnostic’ approach, not because treatment had worked, but because (1) multi-agency involvement meant long-term work may have been continued by a different agency, (2) the starting question of ‘Do we think our service can make a positive difference to this young person’s life?’ rather than ‘What is wrong with this young person?’ may have led to treatment not being continued, and (3) the attitude of viewing a case as problematic when no improvement has occurred after five sessions may have led to treatment not being continued (rather than the case ‘drifting’ on in the system).

Critical Psychiatry and Postpsychiatry

Peter Campbell first used the term ‘postpsychiatry’ in the anthology Speaking Our Minds, which imagines what would happen in a world after psychiatry. Independently, Patrick Bracken and Philip Thomas coined the word later and used it as the title of a series of articles written for Openmind. This was followed by a key paper in the British Medical Journal and a book of the same name. This culminated with the publication by Bradley Lewis, a psychiatrist based in New York, of Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry.

According to Bracken, progress in the field of mental health is presented in terms of ‘breakthrough drugs’, ‘wonders of neuroscience’, ‘the Decade of the Brain’ and ‘molecular genetics’. These developments suited the interests of a relatively small number of academic psychiatrists, many of whom have interests in the pharmaceutical industry, although so far the promised insights into psychosis and madness were yet to be realized. Some psychiatrists have turned to another form of technology, Cognitive Behavioural Therapy, although this does draw attention to the person’s relationship with their experiences (such as voices or unusual beliefs), and focuses on helping them to find different ways of coping, it however, it is based on a particular set of assumptions about the nature of the self, the nature of thought, and how reality is constructed. The pros and cons of this have been explored in some detail in a recent publication.

Framing mental health problems as ‘technical’ in nature involves prioritising technology and expertise over values, relationships and meanings, the very things that emerge as important for service users, both in their narratives, and in service user-led research. For many service users these issues are of primary importance. Recent meta-analyses into the effectiveness of antidepressants and cognitive therapy in depression confirm that non-specific, non-technical factors (such as the quality of the therapeutic relationship as seen by the patient, and the placebo effect in medication) are more important than the specific factors.

Postpsychiatry tries to move beyond the view that we can only help people through technologies and expertise. Instead, it prioritises values, meanings and relationships and sees progress in terms of engaging creatively with the service user movement, and communities. This is especially important given the considerable evidence that in Britain, Black and Minority Ethnic (BME) communities are particularly poorly served by mental health services. For this reason an important practical aspect of postpsychiatry is the use of community development in order to engage with these communities. The community development project Sharing Voices Bradford is an excellent example of such an approach.

There are many commonalities between critical psychiatry and postpsychiatry, but it is probably fair to say that whereas postpsychiatry would broadly endorse most aspects of the work of critical psychiatry, the obverse does not necessarily hold. In identifying the modernist privileging of technical responses to madness and distress as a primary problem, postpsychiatry has looked to postmodernist thought for insights. Its conceptual critique of traditional psychiatry draws on ideas from philosophers such as Heidegger, Merleau-Ponty, Foucault and Wittgenstein.

Anti-Psychiatry and Critical Psychiatry

The word anti-psychiatry is associated with the South African psychiatrist David Cooper, who used it to refer to the ending of the ‘game’ the psychiatrist plays with his or her victim (patient). It has been widely used to refer to the writings and activities of a small group of psychiatrists, most notably R.D. Laing, Aaron Esterson, Cooper, and Thomas Szasz (although he rejects the use of the label in relation to his own work, as did Laing and Esterson), and sociologists (Thomas Scheff). Szasz discards even more what he calls the quackery of ‘antipsychiatry’ than the quackery of psychiatry.

Anti-psychiatry can best be understood against the counter-cultural context in which it arose. The decade of the 1960s was a potent mix of student rebellion, anti-establishment sentiment and anti-war (Vietnam) demonstrations. It saw the rise to prominence of feminism and the American civil rights movement and the Northern Ireland civil rights movement. Across the world, formerly colonised peoples were throwing off the shackles of colonialism. Some of these themes emerged in the Dialectics of Liberation, a conference organised by Laing and others in the Round House in London in 1968.

Critical Psychiatry Network – Activities

CPN is involved in four main areas of work, writing and the publication of academic and other papers, organising and participating in conferences, activism and support. A glance at the members’ publication page on the CPN website reveals in excess of a hundred papers, books and other articles published by people associated with the network over the last twelve years or so. These cover a wide range of topics, from child psychiatry, psychotherapy, the role of diagnosis in psychiatry, critical psychiatry, philosophy and postpsychiatry, to globalisation and psychiatry. CPN has also organised a number of conferences in the past, and continues to do so in collaboration with other groups and bodies. It has run workshops for psychiatrists and offers peer supervision face to face and via videolink. It also supports service user and survivor activists who campaign against the role of the pharmaceutical industry in psychiatry, and the campaign for the abolition of the schizophrenia label. The CPN has published a statement in support.

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What is Sanism?

Published on by Andrew MarshallLeave a comment

Introduction

Sanism, saneism, mentalism, or psychophobia refers to the systemic discrimination against or oppression of individuals perceived to have a mental disorder or cognitive impairment. This discrimination and oppression are based on numerous factors such as stereotypes about neurodiversity. Mentalism impacts individuals with autism, learning disorders, ADHD (attention deficit hyperactivity disorder), FASD (foetal alcohol spectrum disorder), bipolar, schizophrenia, personality disorders, stuttering, tics, intellectual disabilities, and other cognitive impairments.

Mentalism may cause harm through a combination of social inequalities, insults, indignities, and overt discrimination. Some examples of these include refusal of service and the denial of human rights.

Mentalism does not only describe how individuals are treated by the general public. The concept also encapsulates how individuals are treated by mental health professionals, the legal system and other institutions.

The term “sanism” was coined by Morton Birnbaum, a physician, lawyer, and mental health advocate. Judi Chamberlin coined the term “mentalism” in a chapter of the book Women Look at Psychiatry.

Definition

The terms mentalism, from “mental”, and sanism, from “sane”, have become established in some contexts, although concepts such as social stigma, and in some cases ableism, may be used in similar but not identical ways. While mentalism and sanism are used interchangeably, sanism is becoming predominant in certain circles, such as academics. Those who identify as mad, mad advocates, and in a socio-political context where sanism is gaining ground as a movement. The movement of sanism is an act of resistance among those who identify as mad, consumer survivors, and mental health advocates. In academia evidence of this movement can be found in the number of recent publications about sanism and social work practice.

Etymologies

The term “sanism” was coined by Morton Birnbaum during his work representing Edward Stephens, a mental health patient, in a legal case in the 1960s. Birnbaum was a physician, lawyer and mental health advocate who helped establish a constitutional right to treatment for psychiatric patients along with safeguards against involuntary commitment. Since first noticing the term in 1980, New York legal professor Michael L. Perlin subsequently continued its use.

In 1975 Judi Chamberlin coined the term mentalism in a book chapter of Women Look at Psychiatry. The term became more widely known when she used it in 1978 in her book On Our Own: Patient Controlled Alternatives to the Mental Health System, which for some time became the standard text of the psychiatric survivor movement in the US. People began to recognise a pattern in how they were treated, a set of assumptions which most people seemed to hold about mental (ex-)patients regardless of whether they applied to any particular individual at any particular time – that they were incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational etc. It was realised that not only did the general public express mentalist ideas, so did ex-patients, a form of internalised oppression.

As of 1998 these terms have been adopted by some consumers/survivors in the UK and the US, but had not gained general currency. This left a conceptual gap filled in part by the concept of ‘stigma’, but this has been criticised for focusing less on institutionalised discrimination with multiple causes, but on whether people perceive mental health issues as shameful or worse than they are. Despite its use, a body of literature demonstrated widespread discrimination across many spheres of life, including employment, parental rights, housing, immigration, insurance, health care and access to justice. However, the use of new “isms” has also been questioned on the grounds that they can be perceived as divisive, out of date, or a form of undue political correctness. The same criticisms, in this view, may not apply so much to broader and more accepted terms like ‘discrimination’ or ‘social exclusion’.

There is also the umbrella term ableism, referring to discrimination against those who are (perceived as) disabled. In terms of the brain, there is the movement for the recognition of neurodiversity. The term ‘psychophobia’ (from psyche and phobia) has occasionally been used with a similar meaning.

Social Division

Mentalism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent. This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude. Further discrimination may involve labelling some as “high functioning” and some as “low-functioning”; while this may enable the targeting of resources, in both categories human behaviours are recast in pathological terms. According to Coni Kalinowski (a psychiatrist at the University of Nevada and Director of Mojave Community Services[16]) and Pat Risser (a mental health consultant and self-described former recipient of mental health services).

The discrimination can be so fundamental and unquestioned that it can stop people truly empathising (although they may think they are) or genuinely seeing the other point of view with respect. Some mental conditions can impair awareness and understanding in certain ways at certain times, but mentalist assumptions may lead others to erroneously believe that they necessarily understand the person’s situation and needs better than they do themselves.

Reportedly even within the disability rights movement internationally, “there is a lot of sanism”, and “disability organisations don’t always ‘get’ mental health and don’t want to be seen as mentally defective.” Conversely, those coming from the mental health side may not view such conditions as disabilities in the same way.

Some national government-funded charities view the issue as primarily a matter of stigmatising attitudes within the general public, perhaps due to people not having enough contact with those (diagnosed with) mental illness, and one head of a schizophrenia charity has compared mentalism to the way racism may be more prevalent when people don’t spend time together throughout life. A psychologist who runs The Living Museum facilitating current or former psychiatric patients to exhibit artwork, has referred to the attitude of the general public as psychophobia.

Clinical Terminology

Mentalism may be codified in clinical terminology in subtle ways, including in the basic diagnostic categories used by psychiatry (as in the DSM or ICD). There is some ongoing debate as to which terms and criteria may communicate contempt or inferiority, rather than facilitate real understanding of people and their issues.

Some oppose the entire process as labelling and some have responded to justifications for it – for example that it is necessary for clinical or administrative purposes. Others argue that most aspects could easily be expressed in a more accurate and less offensive manner.

Some clinical terms may be used far beyond the usual narrowly defined meanings, in a way that can obscure the regular human and social context of people’s experiences. For example, having a bad time may be assumed to be decompensation; incarceration or solitary confinement may be described as treatment regardless of benefit to the person; regular activities like listening to music, engaging in exercise or sporting activities, or being in a particular physical or social environment (milieu), may be referred to as therapy; all sorts of responses and behaviours may be assumed to be symptoms; core adverse effects of drugs may be termed side effects.

The former director of a US-based psychiatric survivors organization focused on rights and freedoms, David Oaks, has advocated the taking back of words like “mad”, “lunatic”, “crazy” or “bonkers”. While acknowledging that some choose not to use such words in any sense, he questions whether medical terms like “mentally ill”, “psychotic” or “clinically depressed” really are more helpful or indicative of seriousness than possible alternatives. Oaks says that for decades he has been exploring the depths of sanism and has not yet found an end, and suggests it may be the most pernicious ‘ism’ because people tend to define themselves by their rationality and their core feelings. One possible response is to critique conceptions of normality and the problems associated with normative functioning around the world, although in some ways that could also potentially constitute a form of mentalism. After his 2012 accident breaking his neck and subsequent retirement, Oaks refers to himself as “PsychoQuad” on his personal blog.

British writer Clare Allen argues that even reclaimed slang terms such as “mad” are just not accurate. In addition, she sees the commonplace mis-use of concepts relating to mental health problems – including for example jokes about people hearing voices as if that automatically undermines their credibility – as equivalent to racist or sexist phrases that would be considered obviously discriminatory. She characterises such usage as indicating an underlying psychophobia and contempt.

Blame

Interpretations of behaviours, and applications of treatments, may be done in an judgmental way because of an underlying mentalism, according to critics of psychiatry. If a recipient of mental health services disagrees with treatment or diagnosis, or does not change, they may be labelled as non-compliant, uncooperative, or treatment-resistant. This is despite the fact that the issue may be healthcare provider’s inadequate understanding of the person or their problems, adverse medication effects, a poor match between the treatment and the person, stigma associated with the treatment, difficulty with access, cultural unacceptability, or many other issues.

Mentalism may lead people to assume that someone is not aware of what they are doing and that there is no point trying to communicate with them, despite the fact that they may well have a level of awareness and desire to connect even if they are acting in a seemingly irrational or self-harming way. In addition, mental health professionals and others may tend to equate subduing a person with treatment; a quiet client who causes no community disturbance may be deemed improved no matter how miserable or incapacitated that person may feel as a result.

Clinicians may blame clients for not being sufficiently motivated to work on treatment goals or recovery, and as acting out when things are not agreed with or are found upsetting. But some commentators suggest that in the majority of cases this is actually due to the client having been treated in a disrespectful, judgmental, or dismissive manner. Nevertheless, such behaviour may be justified by characterising the client as demanding, angry or needing limits. To overcome this, it has been suggested that power-sharing should be cultivated and that when respectful communication breaks down, the first thing that needs to be asked is whether mentalist prejudices have been expressed.

Neglect

Mentalism has been linked to negligence in monitoring for adverse effects of medications (or other interventions), or to viewing such effects as more acceptable than they would be for others. This has been compared to instances of maltreatment based on racism. Mentalism has also been linked to neglect in failing to check for, or fully respect, people’s past experiences of abuse or other trauma.

Treatments that do not support choice and self-determination may cause people to re-experience the helplessness, pain, despair, and rage that accompanied the trauma, and yet attempts to cope with this may be labelled as acting out, manipulation, or attention-seeking.

In addition, mentalism can lead to “poor” or “guarded” predictions of the future for a person, which could be an overly pessimistic view skewed by a narrow clinical experience. It could also be made impervious to contrary evidence because those who succeed can be discounted as having been misdiagnosed or as not having a genuine form of a disorder – the no true Scotsman fallacy. While some mental health problems can involve very substantial disability and can be very difficult to overcome in society, predictions based on prejudice and stereotypes can be self-fulfilling because individuals pick up on a message that they have no real hope, and realistic hope is said to be a key foundation of recovery. At the same time, a trait or condition might be considered more a form of individual difference that society needs to include and adapt to, in which case a mentalist attitude might be associated with assumptions and prejudices about what constitutes normal society and who is deserving of adaptations, support, or consideration.

Institutional Discrimination

This may be apparent in physical separation, including separate facilities or accommodation, or in lower standards for some than others. Mental health professionals may find themselves drawn into systems based on bureaucratic and financial imperatives and social control, resulting in alienation from their original values, disappointment in “the system”, and adoption of the cynical, mentalist beliefs that may pervade an organisation. However, just as employees can be dismissed for disparaging sexual or ethnic remarks, it is argued by some commentators that staff who are entrenched in negative stereotypes, attitudes, and beliefs about those labelled with mental disorders need to be removed from service organizations. A related theoretical approach, known as expressed emotion, has also focused on negative interpersonal dynamics relating to care givers, especially within families. However, the point is also made by some commentators that institutional and group environments can be challenging from all sides, and that clear boundaries and rights are required for everyone.

The mental health professions have themselves been criticised. While social work (also known as clinical social work) has appeared to have more potential than others to understand and assist those using services, and has talked a lot academically about anti-oppressive practice intended to support people facing various -isms, it has allegedly failed to address mentalism to any significant degree. The field has been accused, by social work professionals with experience of using services themselves, of failing to help people identify and address what is oppressing them; of unduly deferring to psychiatric or biomedical conventions particularly in regard to those deemed most unwell; and of failing to address its own discriminatory practices, including its conflicts of interest in its official role aiding the social control of patients through involuntary commitment.

In the “user/survivor” movement in England, Pete Shaughnessy, a founder of mad pride, concluded that the National Health Service is “institutionally mentalist and has a lot of soul searching to do in the new Millennium”, including addressing the prejudice of its office staff. He suggested that when prejudice is applied by the very professionals who aspire to eradicate it, it raises the question of whether it will ever be eradicated. Shaughnessy committed suicide in 2002.

The psychiatric survivors movement has been described as a feminist issue, because the problems it addresses are “important for all women because mentalism acts as a threat to all women” and “mentalism threatens women’s families and children.” A psychiatric survivor and professional has said that “Mentalism parallels sexism and racism in creating an oppressed underclass, in this case of people who have received psychiatric diagnosis and treatment”. She reported that the most frequent complaint of psychiatric patients is that nobody listens, or only selectively in the course of trying to make a diagnosis.

On a society-wide level, mentalism has been linked to people being kept in poverty as second class citizens; to employment discrimination keeping people living on handouts; to interpersonal discrimination hindering relationships; to stereotypes promoted through the media spreading fears of unpredictability and dangerousness; and to people fearing to disclose or talk about their experiences.

Law

With regard to legal protections against discrimination, mentalism may only be covered under general frameworks such as the disability discrimination acts that are in force in some countries, and which require a person to say that they have a disability and to prove that they meet the criteria.

In terms of the legal system itself, the law is traditionally based on technical definitions of sanity and insanity, and so the term “sanism” may be used in response. The concept is well known in the US legal community, being referred to in nearly 300 law review articles between 1992 and 2013, though is less well known in the medical community.

Michael Perlin, Professor of Law at New York Law School, has defined sanism as “an irrational prejudice of the same quality and character as other irrational prejudices that cause and are reflected in prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry that permeates all aspects of mental disability law and affects all participants in the mental disability law system: litigants, fact finders, counsel, and expert and lay witnesses.”

Perlin notes that sanism affects the theory and practice of law in largely invisible and socially acceptable ways, based mainly on “stereotype, myth, superstition, and deindividualization.” He believes that its “corrosive effects have warped involuntary civil commitment law, institutional law, tort law, and all aspects of the criminal process (pretrial, trial and sentencing).” According to Perlin, judges are far from immune, tending to reflect sanist thinking that has deep roots within our culture. This results in judicial decisions based on stereotypes in all areas of civil and criminal law, expressed in biased language and showing contempt for mental health professionals. Moreover, courts are often impatient and attribute mental problems to “weak character or poor resolve”.

Sanist attitudes are prevalent in the teaching of law students, both overtly and covertly, according to Perlin. He notes that this impacts on the skills at the heart of lawyering such as “interviewing, investigating, counselling and negotiating”, and on every critical moment of clinical experience: “the initial interview, case preparation, case conferences, planning litigation (or negotiation) strategy, trial preparation, trial and appeal.”

There is also widespread discrimination by jurors, who Perlin characterizes as demonstrating “irrational brutality, prejudice, hostility, and hatred” towards defendants where there is an insanity defence. Specific sanist myths include relying on popular images of craziness; an ‘obsession’ with claims that mental problems can be easily faked and experts duped; assuming an absolute link between mental illness and dangerousness; an ‘incessant’ confusion and mixing up of different legal tests of mental status; and assuming that defendants acquitted on insanity defences are likely to be released quickly. Although there are claims that neuroimaging has some potential to help in this area, Perlin concludes that it is very difficult to weigh the truth or relevance of such results due to the many uncertainties and limitations, and as it may be either disregarded or over-hyped by scientists, lawyers or in the popular imagination. He believes “the key to an answer here is a consideration of sanism”, because to a great extent it can “overwhelm all other evidence and all other issues in this conversation”. He suggests that “only therapeutic jurisprudence has the potential power to ‘strip the sanist facade’.”

Perlin has suggested that the international Convention on the Rights of Persons with Disabilities is a revolutionary human rights document which has the potential to be the best tool to challenge sanist discrimination.

He has also addressed the topic of sanism as it affects which sexual freedoms or protections are afforded to psychiatric patients, especially in forensic facilities.

Sanism in the legal profession can affect many people in communities who at some point in their life struggle with some degree of mental health problems, according to Perlin. This may unjustly limit their ability to legally resolve issues in their communities such as: “contract problems, property problems, domestic relations problems, and trusts and estates problems.”

Susan Fraser, a lawyer in Canada who specialises in advocating for vulnerable people, argues that sanism is based on fear of the unknown, reinforced by stereotypes that dehumanise individuals. She argues that this causes the legal system to fail to properly defend patients’ rights to refuse potentially harmful medications; to investigate deaths in psychiatric hospitals and other institutions in an equal way to others; and to fail to properly listen to and respect the voices of mental health consumers and survivors.

Education

Similar issues have been identified by Perlin in how children are dealt with in regard to learning disabilities, including in special education. In any area of law, he points out, two of the most common sanist myths are presuming that persons with mental disabilities are faking, or that such persons would not be disabled if they only tried harder. In this particular area, he concludes that labelled children are stereotyped in a process rife with racial, class and gender bias. Although intended to help some children, he contends that in reality it can be not merely a double-edged sword but a triple, quadruple or quintuple edged sword. The result of sanist prejudices and misconceptions, in the context of academic competition, is that “we are left with a system that is, in many important ways, stunningly incoherent”.

Oppression

A spiral of oppression experienced by some groups in society has been identified, according to some commentators. Firstly, oppressions occur on the basis of perceived or actual differences (which may be related to broad group stereotypes such as racism, sexism, classism, ageism, homophobia etc.). This can have negative physical, social, economic and psychological effects on individuals, including emotional distress and what might be considered mental health problems. Then, society’s response to such distress may be to treat it within a system of medical and social care rather than (also) understanding and challenging the oppressions that gave rise to it, thus reinforcing the problem with further oppressive attitudes and practices, which can lead to more distress, and so on in a vicious cycle. In addition, due to coming into contact with mental health services, people may become subject to the oppression of mentalism, since society (and mental health services themselves) have such negative attitudes towards people with a psychiatric diagnosis, thus further perpetuating oppression and discrimination.

People suffering such oppression within society may be drawn to more radical political action, but sanist structures and attitudes have also been identified in activist communities. This includes cliques and social hierarchies that people with particular issues may find very difficult to break into or be valued by. There may also be individual rejection of people for strange behaviour that is not considered culturally acceptable, or alternatively insensitivity to emotional states including suicidality, or denial that someone has issues if they appear to act normally.

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What is the National Empowerment Centre?

Published on by Andrew Marshall3 Comments

Introduction

The National Empowerment Centre (NEC) is an advocacy and peer-support organisation in the United States (US) that promotes an empowerment-based recovery model of mental disorders. It is run by consumers/survivors/ex-patients “in recovery” and is located in Lawrence, Massachusetts in Essex County.

Brief History

The self-stated mission of NEC is to carry a message of recovery, empowerment, hope and healing to people who have been labelled with mental illness diagnosis. It argues that recovery and empowerment are not the privilege of a few but a process that is possible for everyone to embark on and find help with. Although unconventional to those accustomed only to a narrow medical model, the model is part of a recovery movement that comprises an emerging consensus.

NEC and other groups are working to implement the transformation to a recovery-based system recommended by the New Freedom Commission on Mental Health. It operates a toll-free information and referral line. It organises and speaks at conferences. Its staff have published in professional journals, scholastic books, popular press and alternative publications. NEC has “been involved” in many national boards and committees and in policy consultations at the White House, in Congress, in federal agencies such as HUD, the Social Security Administration, HCFA, the Joint Commission on Hospital Accreditation, and The President’s Commission on Disability, and at the regional and local level with organisations such as HMOs and state divisions of mental health programmes. It has developed educational, training and self-help resources. NEC staff have been featured by CNN, USA Today, The Boston Globe, National Public Radio and talk and radio shows in the US, Canada, Europe and other countries.

NEC conducted qualitative research with people who were severely mentally ill but have met criteria for recovery, from which 13 major principles of how people recover were extracted:

  1. Trusting Oneself and Others
  2. Valuing Self-Determination
  3. Believing You’ll Recover and Having Hope
  4. Believing in the Person’s Full Potential
  5. Connecting at a Human, Deeply Emotional Level
  6. Appreciating That People Are Always Making Meaning
  7. Having a Voice of One’s Own
  8. Validating All Feelings and Thoughts
  9. Following Meaningful Dreams
  10. Relating With Dignity and Respect
  11. Healing From Emotional Distress
  12. Transformation From Severe Emotional Distress
  13. Recovery From Mental Illness

NEC research also identified characteristics distinguishing those in illness and those “in recovery”:

  • Dependent vs self-determining
  • Mental health system support vs Network of friends support
  • Identify solely as consumer or mental patient vs identify as worker, parent, student or other role
  • Medication essential vs one tool that may be chosen
  • Strong emotions treated as symptoms by professionals vs worked through and communicated with peers
  • Global Assessment of Functioning (GAF) score of 60 or below and untrained person would describe labeled person as sick vs score of 61 or above and untrained person would describe the recovered person as not sick (normal)
  • Weak sense of self defined by authority and little future direction vs strong self defined from within and peers, strong sense of purpose and future

NEC developed an approach termed Personal Assistance in Community Existence (PACE). It is based on the premise that people can potentially recover fully from even the most severe forms of mental illness, and on an Empowerment Model of Recovery and prevention. It is an education programme to help shift the culture of mental health from institutional thinking to recovery thinking, designed for people training to become peer coaches, people furthering their recovery, and people learning new skills to help others. It has previously been deliberately contrasted with “PACT” – Program of Assertive Community Treatment – a form of outpatient commitment that was originally designed to enable people to live in the community, rather than in psychiatric hospitals, but according to NEC has become a “coercive, lifelong, and nonclient-directed system with medication compliance as its most important tenet” NEC conducted a national survey of the use of PACE in the mental health system.

NEC co-founder Patricia Deegan was featured on the award-winning radio show a “This American Life” in “Edge of Sanity,” first aired on 1997. Deegan herself is a psychologist who became highly successful despite multiple psychiatric hospitalisations. She was diagnosed as having schizophrenia as a teenager.

Founders

The co-founder and executive director is Daniel B. Fisher, now a board-certified psychiatrist. A graduate of Princeton University, he completed a PhD in biochemistry at the University of Wisconsin, medical training at George Washington University, and a psychiatric residency at Harvard Medical School. While working as a biomedical researcher at the National Institute of Mental Health before he was a psychiatrist, Fisher had a psychotic episode including hallucinations and delusions. After three months at Bethesda Naval Hospital at age 25, which included forced seclusion and antipsychotic haloperidol, he was discharged with a diagnosis of schizophrenia. He was involuntarily hospitalised three times. He reports being influenced by those who were able to show they cared about the person inside and gave him hope that he might some day recover. He went on to become a psychiatrist. He was told during psychiatric training that “You can’t talk to an illness” but believed that talking to the person inside is a key method for building trust and recovery. He has since worked as a psychiatrist in hospitals and clinics, while also being a part of the consumer movement. He said that a very significant part of the reason for becoming a psychiatrist was wanting to bring to the field what he wished had been there when he was going through psychosis He was a member of the White House Commission on Mental Health, 2002-2003.

Laurie Ahern and Patricia Deegan were the co-founders and directors of NEC for several years.

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What is Mad Pride?

Published on by Andrew Marshall1 Comment

Introduction

A flyer for a Mad Pride event in London, 2003. Featured performers include Pete Shaughnessy, Alternative TV, Nikki Sudden, The Fish Brothers, Ceramic Hobs, Melanie Clifford, and Caesar Reel.

Mad Pride is a mass movement of current and former users of mental health services, as well as those who have never used mental health services but are aligned with the Mad Pride framework. The movement advocates that individuals with mental illness should be proud of their ‘mad’ identity.

Mad Pride activists seek to reclaim terms such as “mad”, “nutter”, and “psycho” from misuse, such as in tabloid newspapers, and in order to switch it from a negative view into a positive view. Through mass media campaigns, Mad Pride activists seek to re-educate the general public on the causes of mental disabilities and the experiences of those using the mental health system.

Mad Pride was formed in 1993 in response to local community prejudices towards people with a psychiatric history living in boarding homes in the Parkdale area of Toronto, Ontario, Canada; since then, an event has been held in Toronto every year (except for 1996). A similar movement began around the same time in the United Kingdom, and by the late 1990s, Mad Pride events were organized around the globe, including in Australia, Brazil, France, Ireland, Portugal, Madagascar, South Africa, South Korea, and the United States. Events draw thousands of participants, according to MindFreedom International, a United States mental health advocacy organisation that promotes and tracks events spawned by the movement.

Brief History

Mad Studies grew out of mad pride and the psychiatric survivor framework, and focuses on developing scholarly thinking around “mental health” by academics who self-identify as mad. As noted in Mad matters: a critical reader in Canadian mad studies, “Mad Studies can be defined in general terms as a project of inquiry, knowledge production, and political action devoted to the critique and transcendence of psy-centred ways of thinking, behaving, relating, and being”. Mad studies posits to offer “a critical discussion of mental health and madness in ways that demonstrate the struggles, oppression, resistance, agency and perspectives of Mad people to challenge dominant understandings of ‘mental illness’.” “Mad studies is a growing, evolving, multi-voiced and interdisciplinary field of activism, theory, praxis and scholarship.”

The first known event, held on 18 September 1993, was called Psychiatric Survivor Pride Day, and was organised by and for people who identified as survivors, consumers, or ex-patients of psychiatric practices.

Founders

Mad Pride’s founding activists in the UK include Simon Barnett, Pete Shaughnessy, and Robert Dellar.

Books and Articles

Mad Pride: A celebration of mad culture records the early Mad Pride movement. On Our Own: Patient-Controlled Alternatives to the Mental Health System, published in 1978 by Judi Chamberlin, is a foundational text in the Mad Pride movement, although it was published before the movement was launched.

Mad Pride was launched shortly before a book of the same name, Mad Pride: A celebration of mad culture, published in 2000. On 11 May 2008, Gabrielle Glaser documented Mad Pride in The New York Times. Glaser stated:

“Just as gay-rights activists reclaimed the word queer as a badge of honor rather than a slur, these advocates proudly call themselves mad; they say their conditions do not preclude them from productive lives.”

Culture and Events

Mad Pride and disability pride are both celebrated in July in many countries, including Canada, Ireland, and the United Kingdom. There is a connection to Bastille Day, a French national holiday which occurs annually on 14 July to commemorate the Storming of the Bastille on 14 July 1789. This event was adopted a symbol of Mad Pride, representing liberation and freedom.

The Mad Pride movement has spawned recurring cultural events in Toronto, London, Dublin, and other cities around the world. These events often include live music, poetry readings, film screenings, and street theatre. “Bed push” protests are one form of street theatre unique to Mad Pride events; their aim is to raise awareness about the barriers that prevent people from accessing quality treatment – which disproportionately affect people who are oppressed for other aspects such as race or class – as well as the widespread use of force in psychiatric hospitals. Past events have included British journalist Jonathan Freedland and novelist Clare Allan. Mad Pride cultural events take a variety of forms, such as the South London collective Creative Routes, the Chipmunka Publishing enterprise, and the many works of Dolly Sen.

Bed Push

A Bed Push is a method of activism employed by multiple mental health agencies and advocates as a method of raising awareness about psychiatric care. Activists wheel a gurney through public spaces to provoke discussion about mental health care. MindFreedom has a recipe for a successful Bed Push on their website, urging participants to remain peaceful but also ensure they are seen, using attention-grabbing tactics such as blowing horns, mild traffic disruptions, and loud music. Often patients in psychiatric care feel silenced and powerless, so the act of intentionally securing visibility and showing off resilience is one method of regaining dignity.

Mad Pride Week in Toronto is recognised by the city itself. The festivities surrounding this week are highlighted by the Mad Pride Bed Push, which typically takes place on the 14th of July. The event is staged at Toronto’s Queen Street West “to raise public awareness about the use of force and lack of choice for people ensnared in the Ontario mental health system”. This week is officially run by Toronto Mad Pride which partners a number of mental health agencies in the city. In recent years, some advocates have pushed for Parkdale, Toronto to be renamed MAD! Village, to reclaim pride in its surrounding communities’ long history of struggle with mental health and addictions.

A series of bed push events take place around London each year.

Psychiatric Patient-Built Wall Tours

The Psychiatric Patient-Built Wall Tours take place in Toronto, at the CAMH facility on Queen St West. The tours show the patient-built walls from the 19th century that are located at present day CAMH. The purpose of the tours is to give a history on the lives of the patients who built the walls, and bring attention to the harsh realities of psychiatry.

Geoffrey Reaume and Heinz Klein first came up with the idea of walking tours as part of a Mad Pride event in 2000. The first wall tour occurred on what is now known as Mad Pride Day, on 14 July 2000, with an attendance of about fifty people. Reaume solely leads the tours, and they have grown from annual events for Mad Pride, to occurring several times throughout the year in all non-winter months.

Mad Pride Today

Mad Pride continues to grow with each event. 16 July 2022, in Burlington, VT, Vermonters who identify with the cause came to support it with a showing of speakers, musicians, and food vendors.

In the UK on 14 July 2022, 70 individuals gathered outside Parliament Square to protest the treatment of patients in psychiatric institutions.

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What was the Campaign for John Hunt?

Published on by Andrew Marshall4 Comments

Introduction

John Hunt (born 16 July 1981) is an Irish citizen who was involuntarily detained as a psychiatric patient. The conditions of Hunt’s detention have been the subject of a sustained campaign by his former partner and mother of his child Gráinne Humphrys. He was committed as an involuntary psychiatric patient in 2005 and was detained at a secure psychiatric unit at Our Lady’s Hospital in Cork until August 2011 when he was transferred to the Central Mental Hospital, Dundrum, Dublin. Until 2010 he was not granted leave for any temporary release from the Cork facility to visit his family. As a result of the campaign of his former partner that year, the Cork hospital allowed Hunt six hours of unsupervised leave every two weeks. Later, following a violent altercation with a psychiatric nurse, this leave was rescinded, and Hunt was transferred to the main Irish forensic psychiatric unit in Dundrum.

John Hunt and Gráinne Humphrys.

As of 2013, Humphrys is still being quoted in the Irish press about Hunt’s apparently ongoing psychiatric detention:

“I am very critical about how his admission was dealt with – it was with the use of force and coercion. He didn’t want to take the medication at the time of his admission and I thought, fair enough. I couldn’t understand why there was not a better method of communication that we could use with him, like open dialogue.”

Early Life

At the time of Hunt’s birth, his family lived in the small, coastal town of Greystones in Wicklow, Ireland. His father was a violent alcoholic and his mother had few supports in raising her children. His four-year-old brother drowned when he was eleven years old. Thereafter, Hunt began getting into fights and taking drugs. Humphrys attributes these behaviours to his history of trauma and low self-esteem. His first breakdown occurred shortly after the end of his relationship with his first long-term girlfriend. Humphrys has expressed the view in relation to Hunt’s history that, “trauma and loss, amongst other factors, form the bedrock of John’s problems — his so-called attachment disorder and paranoid schizophrenia.”

Involuntary Committal and Medication

John Hunt was a resident of Cork, Ireland. He experienced a breakdown while his then partner, Gráinne Humphrys, was pregnant with their child, Joshua. Frightened for his safety, Hunt’s mother, Marion Hunt, instigated committal proceedings against her son. As he was deemed a danger to himself, this led to his involuntary committal in 2006 at the Carrig Mór Centre, a Psychiatric Intensive Care Unit (PICU) in Shanakiel, Cork. The Carraig Mór Centre is a two-storey building that was formerly part of the now defunct Our Lady’s Hospital (Cork District Mental Hospital). Hunt was under the management of a forensic psychiatric team in an 18-bed unit for involuntary patients deemed to have behavioural difficulties arising from their mental condition. Subsequent to his admission, he received a variety of diagnoses including drug-induced psychosis, bipolar disorder and schizophrenia. Family visits at Carraig Mór were carried out in a small CCTV-monitored room at the facility that has been described as “cramped” and “uninviting”.

Since his committal Hunt has been forcibly medicated with a diverse range of psychoactive drugs including the typical antipsychotics zuclopenthixol and chlorpromazine, the atypical antipsychotic amisulpride, benzodiazepines and sleeping tablets. They have had various adverse side effects and Humphrys expressed the view that he was “completely over-medicated”. The hospital authorities at Carraig Mór considered Hunt a ‘chronic’ patient and ‘suitable’ for long-term hospitalisation.

Campaign

In 2007, Humphrys began a campaign seeking to end ‘The Incarceration of John’. The Irish Examiner has noted that she gained substantial attention to his case, powerfully portraying him as a lost soul imprisoned against his will and cut off from his family.

In the summer of 2010 former Green Party Senator, Dan Boyle, visited Hunt at the Carraig Mór facility. Senator Boyle acknowledged that Hunt was ‘physically cared for’ but expressed concern ‘about the overriding culture of excessive medication there’. He also noted that Hunt ‘was only allowed minimum contact with the outside world’ and that he did not have access to a rehabilitation programme. Humphrys argues that Hunt’s treatment at the facility damaged him mentally and physically and she has characterised the mental health system as punitive and fostering dependency in patients. She has also alleged that her former partner suffered in the facility as he has been perceived as non-compliant.

Three days after Senator Boyle’s visit to Hunt he called for a debate in the Seanad on ‘the culture of mental health and psychiatric care services’ in Ireland. In his address Senator Boyle referred to his visit to the Cork psychiatric hospital and the fact that Hunt had only seen his son outside of that institution once in the previous four years.

Later in 2010, following the campaign’s expanded media presence and Senator Boyle’s visit to Carraig Mór, Hunt was granted day release without supervision. Hunt was allowed a six-hour pass every two weeks and, according to Humphrys, this reconnection with the world outside of the secure psychiatric hospital gave him ‘new hope for his future’. Reflecting on Hunt’s experience of the mental health system as a patient and her own as the partner and advocate of a psychiatric patient, Humphrys wrote to the medical authorities of the Carraig Mór Centre in early 2011 outlining her grievances, which was reproduced in the press.

Transfer to the Central Mental Hospital

Hunt’s fortnightly passes were rescinded following an incident in June 2011 when he struck a male member of staff. The authorities at the Carraig Mór Centre also barred all visits to Hunt by non-family members. The context and causes of the incident, surrounding an attempted phonecall to his son, and whether it was properly investigated, were highlighted and contested by his family. The authorities at Carraig Mór reported the incident to the Gardaí (the Irish police force) and also sent a report to the Mental Health Commission, who directed that the incident should be addressed by a Mental Health Tribunal. His family and solicitor were not allowed to attend and were not consulted. The tribunal ruled that Hunt should be transferred to the Central Mental Hospital, Dundrum, the main forensic psychiatric facility in Ireland.

The Irish Health Service Executive has responded that it is the goal of the mental health services to “work in a collaborative way with patients and their families to ensure the best outcome possible for people who need mental health services”. They also stated that, “All patients detained under the Mental Health Act have access to independent legal advice. Their detention under the mental health act is reviewed at regular intervals by an independent mental health review tribunal. This tribunal has the power to end the patient’s detention”.

Prior to his transfer Humphreys stated that she and Hunt’s family were apprehensive about the plan to relocate him but that they remained hopeful that better rehabilitative services would be available to him in Dundrum than were accessible at Carraig Mór; she said Hunt was very worried about it but also it may be something new, though he was concerned he would never be released. John McCarthy, a mental health campaigner and the founder of Mad Pride Ireland, likened the facilities of John’s detention as a form of “jail” where patients were held with “no judge, jury or release date”.

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What was the Icarus Project (2002-2020)?

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Introduction

The Icarus Project (2002–2020) was a network of peer support groups and media projects with the stated aim of changing the social stigmas regarding mental health.

Brief History

In 2002, Sascha Altman DuBrul wrote an article published in the San Francisco Bay Guardian about his experiences being diagnosed with bipolar disorder. He founded the Icarus Project with Jacks McNamara, an artist and writer. The Project sought to create spaces where people could talk freely about their lived experiences in regards to their mental health.

Years later, musician-activist Bonfire Madigan Shive and counsellor/activist Will Hall became key members in The Icarus Project’s administration and development.

Mission

The Icarus Project’s stated aims were to provide a:

“support network and education project by and for people who experience the world in ways that are often diagnosed as mental illness.”

The responsibilities of the group are to gather people locally for support, and access to alternatives to mainstream medical diagnosis and treatment. The Project advocates self-determination and caution when approaching psychiatric care. It encourages alternatives to the medical model that is accepted by mental health professionals.

In 2005, journalist Jennifer Itzenson noted that while the Icarus Project may accept those with a wide range of “perspectives” on mental health issues, there is also “an edge of militancy within the group,” particularly among those who reject medication. Itzenson also writes that’s the group’s questioning of medical care is “misguided” and that rejecting medication is a “potentially fatal choice” for those with bipolar disorder.

While Icarus Project staff have described their expertise in social activism, herbalism, and labour organising; none of them are licensed medical or mental health professionals. The Icarus Project advisory board members describe their members as educators, artists, activists, writers, healers, community organisers, and other creative types. Some members of the group identify as Latinx, queer, trans, people of colour or mixed race, and trauma survivors.

Structure/Funding

The Icarus Project was under the fiscal sponsorship of FJC, a non-profit 501(c)3 umbrella organisation arm of an investment firm, based in New York City. The Icarus Project formerly got the bulk of its money from foundation grants, including the Ittleson Foundation, but it also had many individual donors.

Publications

Educational materials published by The Icarus Project have been published in Spanish, German, French, Italian, Japanese, Greek, and Bosnian/Croatian. Some of these publications are listed below:

  • Navigating the Space Between Brilliance and Madness; A Reader and Roadmap of Bipolar Worlds (2004)
  • Friends Make the Best Medicine: A Guide to Creating Community Mental Health Support Networks. (2006)
  • Through the Labyrinth; A Harm Reduction Guide to Coming Off Psychiatric Drugs (2009)
  • Mindful Occupation: Rising Up without Burning Out (2012)
  • Madness and Oppression: Personal Paths to Transformation and Collective Liberation (2015)

Filmography

Films about Icarus Project members are listed below:

  • Ken Paul Rosenthal (2010). Crooked Beauty. 30 min. Poetic documentary featuring Jacks McNamara. In Mad Dance Mental Health Film Trilogy.
  • Ken Paul Rosenthal (2018). Whisper Rapture. 36 min. A doc-opera featuring Bonfire Madigan Shive.

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What is MindFreedom International?

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Introduction

MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations.

Based in the United States, it was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is to protect the rights of people who have been labelled with psychiatric disorders. Membership is open to anyone who supports human rights, including mental health professionals, advocates, activists, and family members. MindFreedom has been recognised by the United Nations Economic and Social Council as a human rights non-governmental organisation (NGO) with Consultative Roster Status.

Origins and Purpose

MindFreedom International is rooted in the psychiatric survivors movement, which arose out of the civil rights ferment of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients rather than the intradisciplinary discourse of antipsychiatry. The precursors of MFI include ex-patient groups of the 1970s such as the Portland, Oregon-based Insane Liberation Front and the Mental Patients’ Liberation Front in New York. The key text in the intellectual development of the survivor movement, at least in the US, was Judi Chamberlin’s 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System. Chamberlin was an ex-patient and co-founder of the Mental Patients’ Liberation Front. Coalescing around the ex-patient newsletter Dendron, in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. In 2005 the SCI changed its name to MFI with David W. Oaks as its director. SCI’s first public action was to stage a counter-conference and protest in May 1990 in New York City at the same time as (and directly outside of) the American Psychiatric Association’s annual meeting.

Many of the members of MFI, who feel that their human rights were violated by the mental health system, refer to themselves as ‘psychiatric survivors’. MFI is a contemporary and active coalition of grassroots groups which are carrying forward the historical tradition of survivor opposition to coercive psychiatry. It does not define itself as an antipsychiatry organisation and its members point to the role which ‘compassionate’ psychiatrists have played in MFI. Activists within the coalition have been drawn from both left and right wing of politics.

MFI functions as a forum for its thousands of members to express their views and experiences, to form support networks and to organise activist campaigns in support of human rights in psychiatry. The coalition regards the psychiatric practices of ‘unscientific labelling, forced drugging, solitary confinement, restraints, involuntary commitment, electroshock’ as human rights violations.

In 2003, eight Mindfreedom members, led by then-executive director David Oaks, went on a hunger strike to publicise a series of “challenges” they had put forth to the American Psychiatric Association (APA), the US Surgeon General and the National Alliance on Mental Illness (NAMI). The eight MFI members challenged the APA, US Surgeon General and NAMI to present MFI with “unambiguous proof that mental illness is brain disorder.” By sustaining the hunger-strike for more than one month, MFI forced the APA and NAMI to enter into a debate with them on this and other issues.

MindFreedom describes their Shield Programme as “an all for one and one for all” network of members. When a registered member is receiving (or is being considered for) involuntary psychiatric treatment, an alert is sent to the MindFreedom Solidarity Network on that person’s behalf. Members of the network are then expected to participate in organised, constructive, nonviolent actions—e.g. political action, publicity and media alerts, passive resistance, etc. – to stop or prevent the forced treatment.

What is the New York Psychoanalytic Society & Institute?

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Introduction

The New York Psychoanalytic Society and Institute — founded in 1911 by Dr. Abraham A. Brill — is the oldest psychoanalytic organisation in the United States.

Outline

The charter members were: Louis Edward Bisch, Brill, Horace Westlake Frink, Frederick James Farnell, William C. Garvin, August Hoch, Morris J. Karpas, George H. Kirby, Clarence P. Oberndorf, Bronislaw Onuf, Ernest Marsh Poate, Charles Ricksher, Jacob Rosenbloom, Edward W. Scripture and Samuel A. Tannenbaum.

The institute was a professional home to some of the leaders in psychoanalytic education and treatment, such as Margaret Mahler, Ernst Kris, Kurt R. Eissler, Heinz Hartmann, Abram Kardiner, Rudolph Loewenstein, Charles Brenner, Thaddeus Ames, Robert C. Bak, and Otto Kernberg.

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What is Psychonautics?

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Introduction

Psychonautics (from the Ancient Greek ψυχή psychē ‘soul, spirit, mind’ and ναύτης naútēs ‘sailor, navigator’) refers both to a methodology for describing and explaining the subjective effects of altered states of consciousness, including those induced by meditation or mind-altering substances, and to a research cabal in which the researcher voluntarily immerses themselves into an altered mental state in order to explore the accompanying experiences.

The term has been applied diversely, to cover all activities by which altered states are induced and utilised for spiritual purposes or the exploration of the human condition, including shamanism, lamas of the Tibetan Buddhist tradition, the Siddhars of Ancient India, sensory deprivation, and archaic/modern drug users who use entheogenic substances in order to gain deeper insights and spiritual experiences. Self-experimentation of psychedelics in groups may foster innovation of alternative medication treatment. A person who uses altered states for such exploration is known as a psychonaut.

Etymology and Categorisation

The term psychonautics derives from the prior term psychonaut, which began appearing in North American works in the late 1950s. The first reference that corresponds to contemporary usages of the term was in the 1965 edition of the Group Psychotherapy journal. A 1968 magazine, Beyond Baroque, refers to Timothy Leary as a psychonaut.

German author Ernst Jünger describes ideas related to psychonautics – in reference to Arthur Heffter – in his 1970 essay on his own extensive drug experiences Annäherungen: Drogen und Rausch (literally: “Approaches: Drugs and Inebriation”). In this essay, Jünger draws many parallels between drug experience and physical exploration—for example, the danger of encountering hidden “reefs.”

Peter J. Carroll made Psychonaut the title of a 1982 book on the experimental use of meditation, ritual and drugs in the experimental exploration of consciousness and of psychic phenomena, or “chaos magic”.

The term’s first published use in a scholarly context is attributed to ethnobotanist Jonathan Ott, in 2001.

Definition and Usage

Clinical psychiatrist Jan Dirk Blom describes psychonautics as denoting “the exploration of the psyche by means of techniques such as lucid dreaming, brainwave entrainment, sensory deprivation, and the use of hallucinogens or entheogens, and a psychonaut as one who “seeks to investigate their mind using intentionally induced altered states of consciousness” for spiritual, scientific, or research purposes.

Psychologist Dr. Elliot Cohen of Leeds Beckett University and the UK Institute of Psychosomanautics defines psychonautics as “the means to study and explore consciousness (including the unconscious) and altered states of consciousness; it rests on the realization that to study consciousness is to transform it.” He associates it with a long tradition of historical cultures worldwide. Leeds Beckett University offers a module in Psychonautics and may be the only university in the UK to do so.

American Buddhist writer Robert Thurman depicts the Tibetan Buddhist master as a psychonaut, stating that “Tibetan lamas could be called psychonauts, since they journey across the frontiers of death into the in-between realm.”

Categorisation

The aims and methods of psychonautics, when state-altering substances are involved, is commonly distinguished from recreational drug use by research sources. Psychonautics as a means of exploration need not involve drugs, and may take place in a religious context with an established history. Cohen considers psychonautics closer in association to wisdom traditions and other transpersonal and integral movements.

However, there is considerable overlap with modern drug use and due to its modern close association with psychedelics and other drugs, it is also studied in the context of drug abuse from a perspective of addiction, the drug abuse market and online psychology, and studies into existing and emerging drugs within toxicology.

Methods

  • Hallucinogens, oneirogens, and especially psychedelics such as peyote, psilocybin mushrooms, LSD and DMT, but also dissociatives and atypical psychedelics such as ketamine, dextromethorphan, Tabernanthe iboga, Amanita muscaria, Salvia divinorum, MDMA, and Cannabis
  • Icaros, which are the songs (i.e. something verbal that is ordinarily perceived as an auditory sensation) the Ayahuasceros sing to induce pictorial representations, rich tapestries of colours and patterns that are visually seen by the listener. (See: synesthesia) The ayahuasca ingredient, harmine, was once known as telepathine because of this group-facilitated activity of singing icaros and the shared perception it cultivates. A shaman who is one of the Ayahuascero people is expected to memorise as many icaros as they can.
  • Disruption of psychological and physiological processes required for usual mental states – sleep deprivation, fasting, sensory deprivation, oxygen deprivation/smoke inhalation, holotropic breathwork
  • Ritual, both as a means of inducing an altered state, and also for practical purposes of grounding and of obtaining suitable focus and intention
  • Dreaming, in particular lucid dreaming in which the person retains a degree of volition and awareness, and dream journals
  • Hypnosis
  • Meditation
  • Meditative or trance inducing dance, like Sufi whirling can also be used to induce altered state of consciousness
  • Prayer
  • Biofeedback and other devices that change neural activity in the brain (brainwave entrainment) by means of light, sound, or electrical impulses, including: mind machines, dreamachines, binaural beats, and cranial electrotherapy stimulation
  • Guided Imagery and Music (GIM) refers to all forms of music-imaging in an expanded state of consciousness, including not only the specific individual and group forms that music therapist and researcher Helen Bonny developed, but also all variations and modifications in those forms created by her followers.
  • These may be used in combination; for example, traditions such as shamanism may combine ritual, fasting, and hallucinogenic substances.

Works and Notable Figures

Works such as Confessions of an English Opium-Eater by Thomas De Quincey, The Hasheesh Eater by Fitz Hugh Ludlow, and On Hashish by Walter Benjamin have psychonautic elements insofar as they explore human and drug-induced experiences. They may be considered precursors to psychonautic literature, but they are not psychonautic works in their own right.

One of the best known psychonautic works is Aldous Huxley’s The Doors of Perception, which recounts his experience after taking 400mg of mescaline. The American physician, neuroscientist, psychoanalyst, philosopher, writer and inventor John C. Lilly was a well-known psychonaut. Lilly was interested in the nature of consciousness and, amongst other techniques, he used isolation tanks in his research.

Ken Kesey is an author well-known for accounts of his experimentation with psychedelic drugs. Philosophical- and Science-fiction author Philip K. Dick has also been described as a psychonaut for several of his works such as The Three Stigmata of Palmer Eldritch.

Another influential figure is the psychologist and writer Timothy Leary. Leary is known for controversial talks and research on the subject; he wrote several books including The Psychedelic Experience. Another widely known name is that of American philosopher, ethnobotanist, lecturer, and author Terence McKenna. McKenna spoke and wrote about subjects including psychedelic drugs, plant-based entheogens, shamanism, metaphysics, alchemy, language, culture, technology, and the theoretical origins of human consciousness.

Among the most influential figures are undoubtedly Alexander Shulgin and Ann Shulgin who together authored PiHKAL and TiHKAL, a pair of books which contain fictionalised autobiographies and detailed notes on over 230 psychoactive compounds. Some present-day psychonauts refer to themselves as “Shulginists” to denote a belief in the principles they identify in Shulgins’ work.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Psychonautics >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Specific Phobia?

Published on by Andrew MarshallLeave a comment

Introduction

Specific phobia is an anxiety disorder, characterised by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

Although fears are common and normal, a phobia is an extreme type of fear where great lengths are taken to avoid being exposed to the particular danger. Phobias are considered the most common psychiatric disorder, affecting about 10% of the population in the US, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), (among children, 5%; among teens, 16%). About 75% of patients have more than one specific phobia.

It can be described as when patients are anxious about a particular situation. It causes a great load of difficulty in life. Patients have a lot of distress or interference when functioning in their daily life. Unreasonable or irrational fears get in the way of daily routines, work, and relationships due to the effort that a patient makes to avoid the terrifying feelings associated with the fear.

Females are twice as likely to be diagnosed than males with a specific phobia (although this can depend on the stimulus).

Children and adolescents who are diagnosed with a specific phobia are at an increased risk for additional psychopathology later in life.

Signs and Symptoms

Fear, discomfort or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. The main behavioural sign of a specific phobia is avoidance. The fear or anxiety associated with specific phobia can also manifest in physical symptoms such as an increased heart rate, shortness of breath, muscle tension, sweating, or a desire to escape the situation.

Causes

The exact cause of specific phobias is not known. The mechanisms for development of specific phobias can be distinguished between innate (genetic and neurobiological) factors, and learned factors.

In neurobiology, one explanation proposed for specific phobia is that the typical activation of the amygdala in response to stimuli may be exaggerated due to pathological changes. According to this theory, a deficiency in amygdala habituation may also contribute to the persistence of non-experiential phobia. Certain phobias that are less lethal (e.g. dogs) seem to be more frequently observed and easily acquired in comparison to potentially lethal fears which are more relevant to developed human society (e.g. cars and guns). This was theorised to be due to biological adaptation being passed through evolution which makes recent threats less prone to easy acquisition. However, a 2014 study found evidence against this evolutionary theory, which stated:

“Our findings are inconsistent with the hypothesis that fears/phobias of individual stimuli result from genetic and environmental factors unique to that stimulus. Instead, we observed substantial sharing of risk factors across individual fears.”

There is also evidence for the validity of a genetic component contributing to blood-injection-injury phobias and animal phobias, although this evidence did not support the idea that other specific phobias had genetic influence. Blood-injection-injury phobias are also believed to be the most heritable among specific phobias.

The classical conditioning model of learning has also been used to suggest that a phobia will be learned when an event that causes a fear or anxiety reaction is paired with a neutral event. An example of this model is when being near a dog (neutral event) is paired with the emotional experience of being bitten by a dog, resulting in a chronic fear which is described as a specific phobia to dogs. An alternative proposed mechanism of association is through observational learning. According to this theory, a person may internalise another person’s fears about a specific object or situation through observation of their reactions.

Diagnosis

Diagnosis in the ICD or the DSM requires a marked fear, anxiety or avoidance that is long-lasting (greater than six months) and consistently occurs in the presence of the feared object or situation. The DSM-5 that the fears should be out of proportion to the danger posed, compared to the ICD-10 which specifies that the symptoms must be excessive or unreasonable. Minor differences have persisted between the ICD-11 and DSM-5.

In the DSM-5, there are several types which specific phobia can be classified under:

  • Animal type – Including fear of spiders (arachnophobia), insects (entomophobia), dogs (cynophobia), or snakes (ophidiophobia).
  • Natural environment type – Including fear of water (aquaphobia), heights (acrophobia), lightning and thunderstorms (astraphobia), or aging (gerascophobia).
  • Situational type – Including the fear of small confined spaces (claustrophobia), or the dark (nyctophobia).
  • Blood/injection/injury type – Including fear of medical procedures, including needles and injections (trypanophobia), fear of blood (hemophobia) and fear of getting injured (traumatophobia).
  • Other – Situations which can lead to choking or vomiting, and children’s fears of loud sounds or costumed characters.

Although the avoidance resulting from specific phobia is comparable to other anxiety disorders, differential diagnosis is done through examining underlying causes for the behaviour. Agoraphobia is also considered distinct from specific phobia, along with substance use disorders, and avoidant personality disorder. The occurrence of panic attacks is not itself a symptom of specific phobias and falls under the criteria of panic disorder.

Treatment

There are a variety of treatment options available for specific phobias, most of which focus on psychosocial interventions. Different psychological treatments have varying levels of effects depending on the specific phobia being addressed.

Cognitive Behavioural Therapy (CBT)

CBT is a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behaviour. CBT represents the gold standard and first line of therapy in specific phobias. CBT is effective in treating specific phobias primarily through exposure and cognitive strategies to overcome a person’s anxiety. Computer-assisted treatment programs, self-help manuals, and delivery by a trained practitioner are all methods of accessing CBT. A single session of CBT in one of these modalities can be effective for individuals who have a specific phobia.

Exposure Therapy

Exposure therapy is a particularly effective form of CBT for many specific phobias, however, treatment acceptance and high drop-out rates have been noted as concerns. In addition, a third of people who complete exposure therapy as a treatment for specific phobia may not respond, regardless of the type of exposure therapy. Other interventions have been successful for particular types of specific phobia, such as virtual reality exposure therapy (VRET) for spider, dental, and height phobias, applied muscle tension (AMT) for needle phobia, and psychoeducation with relaxation exercises for fear of childbirth. With exposure therapy, a type of cognitive-behavioural therapy, clinically significant improvement was experienced by up to 90% of patients. While very long-term outcomes remain unknown, many of the benefits of exposure therapy persisted after one year. Treatment may be more successful at reducing symptoms in people with low trait anxiety, high motivation, and high self-efficacy entering exposure therapy. In addition, high cortisol levels, high heart rate variation, evoking disgust, avoiding relaxation, focusing on cognitive changes, context variation, sleep, and memory-enhancing drugs can also reduce symptoms following exposure therapy.

Exposure can be “live”(in real life) or imaginal (in ones imagination) and can involve:

  • Systematic desensitisation: A therapy that exposes the person to increasing levels of vivid stimuli gradually and frequently, while instructed to relax.
  • Flooding: A therapy that exposes the person with a specific phobia to the most fearful stimulus first (i.e. the most intense part of the phobia). Patients are at great risk for dropping out of treatment as this method repeatedly exposes the patient to the fear.
  • Modelling: This method includes the clinician approaching the feared stimuli while the patient observes and tries to repeat the approach themselves.

Exposures that are imaginal are less effective.

Specifically for acrophobia, in-vivo exposure (exposure to real-world height-scenarios while maintaining anxiety at controlled levels) has been shown to significantly improve measures of anxiety in the short-term, but this effect decreased over a longer term. Likewise, virtual reality exposure was statistically significant in some measures of anxiety reduction, but not others.

Pharmacotherapeutics

As of late 2020, there is limited evidence for the use of pharmacotherapy in the treatment of specific phobia. Pharmacological treatments are typically used in combination with behaviourally-focused psychotherapy, as introducing pharmacological interventions independently may result in relapsing of symptoms. Different treatments are better suited for certain types of specific phobia. For instance, beta blockers are useful in those with performance anxiety. The selective serotonin re-uptake inhibitors (SSRIs), paroxetine and escitalopram, have shown preliminary efficacy in small randomised controlled clinical trials. However, these trials were too small to show any definitive benefits of anxiolytic medication alone in treating phobia. Benzodiazepines are occasionally used for acute symptom relief, but have not been shown to be effective for long-term treatment. There are some findings suggesting that adjuvant use of the NMDA receptor partial agonist, d-cycloserine, with virtual reality exposure therapy may improve specific phobia symptoms more than virtual reality exposure therapy alone. As of 2020, studies on the use of adjunct d-cycloserine are inconclusive.

Prognosis

The majority of those that develop a specific phobia first experience symptoms in childhood. Often individuals will experience symptoms periodically with periods of remission before complete remission occurs. However, specific phobias that continue into adulthood are likely to experience a more chronic course. Specific phobias in older adults has been linked with a decrease in quality of life. Those with specific phobias are at an increased risk of suicide. Greater impairment is found in those that have multiple phobias. Response to treatment is relatively high but many do not seek treatment due to lack of access, ability to avoid phobia, or unwilling to face feared object for repeated CBT sessions.

Epidemiology

Specific phobia is estimated to affect 6–12% of people at some point in their life. There may be a large amount of underreporting of specific phobias as many people do not seek treatment, with some surveys conducted in the US finding that 70% of the population reports having one or more unreasonable fears.

Specific phobias have a lifetime prevalence rate of 7.4% and a one-year prevalence of 5.5% according to data collected from 22 different countries. The usual age of onset is childhood to adolescence. During childhood and adolescence, the incidence of new specific phobias is much higher in females than males. The peak incidence for specific phobias amongst females occurs during reproduction and childrearing, possibly reflecting an evolutionary advantage. There is an additional peak in incidence, reaching nearly 1% per year, during old age in both men and women, possibly reflective of newly occurring physical conditions or adverse life events. The development of phobias varies with subtypes, with animal and blood injection phobias typically beginning in childhood (ages 5–12), whereas development of situational specific phobias (i.e. fear of flying) usually occurs in late adolescence and early adulthood.

In the US, the lifetime prevalence rate is 12.5% and a one-year prevalence rate of 9.1%. An estimated 12.5% of US adults experience specific phobia at some time in their lives and the prevalence is approximately double in females compared to males. An estimated 19.3% of adolescents experience specific phobia, but the difference between males and females is not as pronounced.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Specific_phobia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.