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Fall/ Winter 2003/4 Edition GUERILLA
WARFARE FOR ICSPP MEMBERS: (OR
THE POOR MAN?S GUIDE TO FIGHTING THE SYSTEM) How
to Effectively Attack the Psychopharmacological Power Structure
From Within By
Lloyd Ross, Ph.D. U.S.
Regional Director
As a Psychologist in full time individual private practice, working alone, I,
as well as many colleagues in similar situations, feel at first glance to be
powerless to make a difference in the ?mental health steamroller.? Also
as a Psychologist, I have become disillusioned with my professional
organizations, the American Psychological Association and the New Jersey Psychological
Association. These organizations are guilds designed to promote
Psychology as a profession and to provide it with some power, something that I
have no problem with as all professions have a very appropriate need to do
this, just like carpenters and plumbers. However, in the fields of
medicine and ?mental health? these Guilds (a more accurate name), pawn
themselves off as professional organizations that are designed to help the
consumer get better and more efficient treatment. That is certainly not
the primary goal of any of these organizations, or even the secondary goal.
Below, I have compiled a guide, composed of a number of tactics, all of which I
have used and continue to use at various times and with varying effects to
subvert, undermine, expose, and generally attack the psychopharmacological
industry as it tries to impinge on my profession, and these attacks take place
from within my profession. Although
I am speaking as a psychologist, most of these tactics are applicable to psychiatrists,
social workers, counselors, educators, nurses and physicians as well.
Often, these organizations, in establishing their ?turf,? collide seriously
with what is in the public interest, and many of their members are aware of
this. However, they feel helpless to challenge it. Also, they find that
if they challenge and oppose their guild directly, they will be swept off to
the side by the powers that be. A
Regional Approach: I
have retained my membership in the New Jersey Psychological Association for
only one reason, and that is to use that membership to sway people away from
the great push toward prescription privileges for psychologists.
Prescription privileges would turn psychologists, at least those who are not
very successful or well trained or well equipped ICSPP (212) 585-3758
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practice psychotherapy, into miniature psychiatrists, writing prescriptions for
drugs and
boosting their incomes. That last point, by the way seems to be a
key. Mention it and you can get most psychologists to salivate like
Pavlov?s dog. Most of these prescription privilege advocates seem to have
no real concern about the fact that these drugs can do much more harm than good.
These are some of the tactics used by me to hold at bay the onslaught of
drugging by psychologists.1) At every N.J.P.A. conference (2 per year), I
provide literature for the attendees. Most organizations have several
tables for handouts and other give-away materials. 2) Several years ago, I
volunteered to be a member of the N.J.P.A. Program Committee, the people who
compose and organize conferences. When you are a member of such a
committee, you have a big say in what programs and speakers are invited to the
State Conferences. I also encouraged several colleagues, all of whom are
ICSPP members, to volunteer for the Program Committee. As a result,
psychologists in
In the Spring, 2004 conference coming up, which will take place on March 27,
2004, Dr, Burt Karon will be giving an all day workshop on treating
Schizophrenic patients without medication. Any ICSPP members interested
in coming, email me at LLOYDROSS1@WORLDNET.att.net.
It took two years of maneuvering for them to go along with this workshop, but
well worth it.
3) A committee of prescription privilege advocates will be giving a panel
presentation next year and I volunteered to be their liaison with the program
committee, (i.e. I get to run the show.) Although I was unable to
block the presentation entirely. I have set up guidelines for the program where
during the first half of the program, their committee members will make their
presentation. The second half of the program will be a question and
answer format with me as moderator. All questions get filtered through
me. Need I spell the scene out any further?
4) Another ripe and approachable place to attack is in the various Divisions of
APA, such as the Psychotherapy Division or Independent Practice Division, or
Social Action Division. The programs that they set up can be greatly
influenced by us as individuals. Be creative!!! In each of your
organizations, be it the American Psychological Association, The American
Psychiatric Association, The American Association of Social Workers, The
National Education Association, the American Personnel and Guidance
Association, the American Rehabilitation Counseling Association, etc., as well
as all the Regional and State Associations, some of them competing with each
other, there is room for your personal touch which can influence people.
I strongly believe that our own efforts here in
So let?s go out there and exert some power and influence what happens. We
have a lot more clout than we sometimes think we do. Let?s use it
creatively. Dr.
Ross is in full time private practice in ________________________________________________________________________ Recovery:
Responsibilities and Roadblocks by
Jim Gottstein October
2003 Copyright
? Jim Gottstein 2003. All Rights Reserved. In reviewing the scientific, mental health practitioner, and
C/S/X[1] literature regarding recovery from
serious mental illness and analyzing them it really is quite clear both (a)
what works and (b) what impedes. It is also quite clear many more people
can recover from serious mental illness than currently do under Western
(primarily medication) treatment. This article discusses the
responsibilities for and roadblocks to recovery that has resulted in this
unacceptable situation. First, however, some definitions and
background. Definitions and Background
Definitions
The term "what works" is meant to be very broad and
much more a way of thinking and principles as contrasted with any particular
technique(s). There is a very valid saying pertaining to mental illness
that "everything works for some and nothing works for all."
There are, however, some principles and specific steps that consistently come
up as being helpful in getting people over serious mental illness. Mental Illness and particularly Serious Mental Illness refers
to people who have suffered from psychosis although the same principles
probably apply to people diagnosed with depression who have never suffered
psychosis, etc., and it is not intended to denigrate their suffering. The
problem with "mental illness" as a term is there is a lot of
controversy over what it really refers to and the way it is used in the
dominant treatment modality (i.e, some type of brain pathology) does not appear
to comport with reality.[2] On the other hand, the C/S/X and
unbiased scientific literature agree that in the vast majority of cases, leaving
aside brain injury and other clearly organic causes, "mental illness"
or psychosis is the result of events in the person's life.[3] Recovery from serious mental illness means a lot of different
things to a lot of different people. Dr. Courtenay Harding, probably the
pre-eminent researcher on long-term outcomes for people diagnosed with serious
mental illness uses the following definition: No current signs and symptoms of any mental illness, no
current medications, working, relating well to family and friends, integrated
into the community and behaving in such a way as to not being able to detect
having ever been hospitalized for any kind of psychiatric problems.[4] Interestingly, within the C/S/X community, Recovery is often
defined much more loosely. In April of 2003, the NO (National
Organization) List, an Internet listserv had a discussion thread on exactly
this topic: Some of the responses included: ?
An individual's opportunity for social activities and places to go is no
different than any other citizen. ?
An individual has paid or volunteer work if they wish to. ?
An individual has a secure roof over his/her head ?
An individual is no longer bothered by symptoms that monopolize his/her
consciousness and days and nights ?
An individual may or may not take medications, do exercises physical or
spiritual. ?
What is recovered is a sense of self that is not defined by illness, but by
abilities and interests and hope for the future. ======== I appreciate the literal meaning of
recovery; to recover is to "take back." Thus "recovery"
is the process of taking back. As I recover - I take back my life. ======== To get back a sense of self that is
not defined by illness but by abilities and interests and hope for the future.
======== For me "recovery" has been a very painful and
unfinished, day to day struggle. It takes medicine, ongoing therapy,
friends, meaningful work, withdrawing for periods of time,
keeping-on-keeping-on. Thus, recovery means a lot of different things to different
people.[5] As used here, recovery means
getting past a diagnosis of mental illness to a point where a person enjoys
meaningful activity, has relationships, and where psychiatric symptoms, if any,
do not dominate or even play a major role in their life. Background
The importance of award winning science/medical writer,
Robert Whitaker's book, Mad in I bumped into several studies . . . that really struck me as
odd. Over the past twenty-five years, outcomes for people in the And
after his exhaustive research, the very last sentence of the book concludes: [T]oday we can be certain of only one thing: The day
will come when people will look back at our current medicines for schizophrenia
and the stories we tell to patients about their abnormal brain chemistry, and
they will shake their heads in utter disbelief. In between, Whitaker describes the studies that show how
rather than cure chemical imbalances, these drugs, if taken long enough, cause
permanent changes in the brain which make relapses much more likely. Even
before permanent changes in the brain occur, when someone quits withdrawal
(also often called "rebound") effects from the drugs create symptoms
that are assumed to be the underlying "mental illness" and the
response is usually to restart medications, often at a higher dose.[7] Dr. Bert Karon, notes: Ann-Louise Silver, in a recent paper (Silver, 2000), said
that when she first worked at Chestnut Lodge, her schizophrenic patients were
not medicated. In more recent years, all of her patients were medicated as a
matter of policy. In the premedication days, she had patients who got
romantically involved, got married, had children, and related to their spouses
and children. In the medication era, none of her patients developed
stable marriages and stable relations with spouse and children.[8] In her seminal Vermont Longitudinal studies, Dr. Harding
found that: This group of back-ward patients represented the most
severely ill group from In the
follow-up study (Vermont II), Dr. Harding et. al., found [O]ne-half to two two-thirds of the sample had achieved
considerable improvement or recovered, in contrast to statements in DSM-III
that predict a poor outcome for schizophrenic Patients.[10] In her Myths article Dr. Harding reports: Studies have consistently found that half to two thirds of
patients significantly improved or recovered, including some cohorts of very
chronic cases. This is
in the context of correcting what she calls the myth: "Once a
schizophrenic always a schizophrenic."[11] What Works
Love, support, caring, connections, a safe home, spiritual
support, and most important, hope. And taking responsibility. These
are the things that work. People who recover cite hope and "someone
believed in me; someone believed that I could do it" as the most important
things.[12] Research bears this out.[13] A relatively small percentage of
people cite medications as important. In Oryx Cohen's study,
"Psychiatric Survivor Oral Histories: Implications for Contemporary Mental
Health Policy: participants' most common recovery strategy was the support
of friends and family (at 72 percent). Social activism, exercise, and
one-on-one therapy were also commonly reported (69, 61, and 58 percent
respectively). Group therapy and psychiatric drugs were only reported by
25 percent of the participants. [14] Cohen goes on to conclude: Given the difficulties that participants experienced with
psychiatric drugs, it is not surprising that only a fourth felt they assisted
in their recovery process. This also happens to be the number of people
currently taking medications, and with just two exceptions, the people who felt
medications helped were those who were currently taking them.[15] It is
critical to recognize the importance of this latter finding, which is that the
people who recover with medications are the ones who decide for themselves that
they are helpful. Other conclusions in Cohen's study are: [I]t wasn't one "magic bullet" that ?cured? these
people. Instead a combination of strategies and circumstances allowed
participants to improve their sense of well-being. Along with the
importance of having support, participants indicated the importance of things
like diet, reading literature, and
spirituality.[16] Perhaps most importantly, for the
majority of participants there came a time when it "all clicked,"
when they realized that nobody was going to recover for them, they were going
to have to find a way to do it themselves.[17] In The Experience of Recovery, Patricia Deegan discusses the
importance of hope, love and support when she talked about hers and a friend's
recovery process: Neither the paralyzed man nor I could remember a specific
moment when the small and fragile flame of hope and courage illuminated the
darkness of our despair. We do remember that even when we had given up,
there were those who loved us and did not give up. They did not abandon
us. They were powerless to change us and they could not make us
better. They could not climb this mountain for us but they were willing
to suffer with us. . . . Their love for us was like a constant
invitation, calling us forth to be something more than all of this self-pity
and despair. The miracle was that gradually my friend and I began to hear
and respond to this loving invitation. For 14 years my friend had slouched in front of the
television in the hell of his own despair and anguish. For months I sat
and smoked cigarettes until it was time to collapse back into a drugged and
dreamless sleep. But one day, something changed in us. A tiny, fragile
spark of hope appeared and promised that there could be something more than all
of this darkness. This is the third phase of recovery. This is the
mystery. This is the grace. This is the birth of hope called forth
by the possibility of being loved. All of the polemic and technology of
psychiatry, psychology, social work and science cannot account for this
phenomenon of hope. But those of us who have recovered know that this
grace is real. We lived it.[18] Dr. Harding, in her Myths paper, describes how the research
shows there is always the possibility for recovery: Even in the second and third decades of illness, there is
still potential for full or partial recovery." All of the recent long-term
follow-up investigators have recorded the same findings[19] Dr. Loren Mosher, in the Soteria-House studies and their
progeny has proven with even more scientific rigor these principles work.[20] In Dr. Mosher's and Dr. Lorenzo's
terrific book Community Mental Health a Practical Guide[21], it is stressed the most important
things are to support people; to be with them, rather than do to them, to let
them be themselves, to establish a therapeutic relationship by rejecting
coercion and to allow people to recover through support mechanisms that solve
their real problems. So, we really do know what works and can move to
responsibilities and roadblocks. Responsibilities
From what has already been said, it is clear responsibility
for recovery rests in the person wanting to recover. No doctor or spouse
or friend or mental health worker can do it for her. The person has to do
it. She can get help. She needs love and support to do it, but it
is her task and it will likely be a lot of work. Only she knows what is going on in her head and thus it is
her responsibility to learn both to recognize the warning signs and what sorts
of things help. Even though these are the person's responsibility, it is
important to recognize these learning processes are not necessarily a steady
progression. In order to learn what works it is necessary to try things
and not necessarily everything will work. The learning process may very
well involve relapses. This is part of the recovery process; part of the
learning process and should not be viewed as failure. It is the responsibility of other people to let this process
occur. What happens now is that the system, including loved ones, are so
afraid of relapses they try to keep people "safe" with the drugs or other
treatments, such as Electroshock (yes, it is coming back in the U.S.).
However, these drugs have been shown, for most people, to be both physically
harmful and unhelpful in the recovery process, especially if used
long-term. It is the responsibility of others to allow the person to work
out what works for him and her and not resort to forcing drugs, ECT or other
treatments on the person when this occurs. Remember, it is ultimately the
responsibility of the person to recover and forcing anything on the person is
counterproductive to that. It is also the responsibility of others to let people try the
things they want to try. It turns out that people tend to have pretty
good ideas about what sorts of things might help them. It may be violin
lessons.[22] Even if the idea doesn't
ultimately turn out to be successful, it is part of the recovery process
because the person needs to find out for herself it isn't part of the answer.
Unless the person is allowed to try it, she will be stuck on it. On the
other hand, if the person tries the idea and it doesn't work out the way it was
hoped, she will have learned that and be able to move on. It is her
responsibility to do this and it is other people's responsibility to let it
happen. However, there are other responsibilities involved.
Perhaps the biggest is the responsibility of the mental health profession to
honestly re-evaluate its assumptions and treatments. All the evidence
shows the profession's belief system about the incurability or chronicity of
serious mental illness is false. All the evidence shows that the
long-term use of neuroleptics and other psychiatric drugs prevent recovery in
the majority of cases, cause serious health problems, including early
death. No evidence shows serious mental illness is the product of a brain
disease or a "chemical imbalance" in the brain.[23] It is the mental health
profession's responsibility to conform their practices to reality. It is
the mental health profession's responsibility to be honest. To be honest
to itself and to be honest to its patients. No therapeutic relationship
can be formed if the therapist is not honest to her patient. Just because
someone may have been diagnosed with a serious mental illness does not mean
they can't tell when they are being lied to. The lies are very
destructive. There is a flip side to responsibility. That is the
absolution from responsibility that results from believing mental illness is a
disease of the brain; that it is a chemical imbalance. This is the
seduction of the bio-medical model. If one accepts it, no one is
responsible for it. Parents are absolved from all responsibility in
creating the mental illness. That is why the main US parents
organization, NAMI (National Alliance for the Mentally Ill) has embraced the
idea so completely to the exclusion of consideration of any other explanation and
its rejection of all the evidence against this disproven theory. What
they fail to see is responsibility does not equate with blame. Sure, one
can blame parents who physically and/or sexually assault their children, which
so often results in serious psychiatric symptoms. More often, however, parents are loving and do the best they
can, but serious mental illness can still arise out of the relationship.
One can't really tell how kids interpret things. In the famous
biographical novel, "I Never Promised You a Rose Garden" one can see
how family interactions and a child's interpretation of a certain event, caused
a very severe psychosis years after the event. In another instance, a
child had a really hard time adjusting to the arrival of his sister and perceived
everything as unfair. He acted out and was diagnosed with mental
illness. Very heavy medication followed with a poor prognosis until
common sense prevailed and he was allowed to work through his issues. He
is now fine. Responsibility does not mean blame. It means
responsibility. When responsibility for mental illness is attributed to a
defective brain, it relieves everybody of responsibility for both the cause and
the cure. It gives responsibility at this point to pills. Pills
we now know don't work for most people in terms of recovery. This
absolution from responsibility is true for the person as much or more than the
parents or providers. Being labeled with a serious mental illness today
is virtually absolution from responsibility. Bad behavior is excused as
"part of the illness." There is no responsibility on anyone for
recovery because it is an incurably defective brain. These failures of responsibility lead to roadblocks for
recovery. Roadblocks
There are many roadblocks to recovery, but the big three are
(1) Destruction of Hope, (2) Abdication of Responsibility, and (3) Insistence
on long-term medication. All three of these are manifestations of the
same fundamental mistake that mental illness is the product of a defective
brain. Destruction of Hope
Because of the fallacious assumption that mental illness is
the product of a defective brain, people are told they will never get better;
they will never live full, fulfilling lives. In short, they are told to
give up hope. Do we really want a mental health system who's operating
principle is " Abandon Hope All Ye Who Enter Here?" Of course
not. Most importantly, we have seen that hope is the most important
element in recovery. That is why Drs. Mosher and Burti say recovery
should be the expectation. We must remove the roadblock of the myth that
people don't recover from serious mental illness. We must. Abdication of Responsibility
It is a sort of double negative, but we must also remove the
roadblock of the abdication of responsibility. This roadblock also arises
from the myth of the biological cause of mental illness and the person is
therefore not responsible for her actions. This roadblock arises from
excusing bad behavior because "it is the illness." We know
recovery is ultimately the responsibility of the person. It is hard work,
there can and most often are setbacks, sometimes many, and we mustn't blame
people who falter. What we can do is encourage them in recognizing and
assuming their responsibility. We need to remove the roadblock to
recovery created by excusing behavior because it is "caused by the
illness." This doesn't mean being intolerant of behavior that is
merely "weird" or beyond societal norms. It does mean being
clear about truly harmful behaviors being unacceptable and the person's
ultimate responsibility. It also means being clear that only by assuming
personal responsibility can a person recover. Similarly, we need to remove the road block that exists
because other people are absolved from responsibility for their part in the
problem. Again, responsibility does not necessarily equate to blame, but
if we do not acknowledge other people's part in the process, we are not being
honest. Insistence on Long-Term Medication
While psychiatric medications, particularly the neuroleptics
(including the newer "atypicals"), may help some people in the short
term, it is crystal clear long-term use is counterproductive to achieving
recovery for most people. We must quit insisting that virtually everybody
diagnosed with serious mental illness has to take these medications
indefinitely. It is not the truth, it is harming people, and it is
preventing recovery for many, many people. Conclusion
Recovery. Responsibility. Roadblocks. We
know recovery is possible for many more people diagnosed with serious mental
illness than currently do so. The most important reasons for this are
failures of responsibility. The responsibility to be honest. The
responsibility to be responsible. The responsibility to offer hope.
The responsibility to stand up to the drug companies' lies. These
failures of responsibility are roadblocks to recovery that must be removed for
more people to recovery.
____________________________________________________________________________________________________________________________________ ICSPP
2003 Conference By
Robert Sliclen Treating
the Difficult Child: ADHD, Bipolar and Other Diagnoses: Challenging the Status
Quo Peter Breggin began the Saturday morning plenary
sessions. In opening his presentation, he noted that almost everything we
call a breakdown is a breakdown of meaning, that is, one of spirit, not
of mechanics. While cautioning all to consider that a real physical
issue may be present, he distinguished that a real disease is an actual entity;
not one that shows itself only in limited settings or only with certain people.
A disease is not a mental disorder. Next, David Cohen presented a comparative study of stimulant
research. He reviewed a series of published studies of the clinical
trials known as randomly controlled trials, or RCTs, noting the design flaws
and the multiple and selective publications of the material from a single
original study. Strattera, although marketed as a non-stimulant ,
appears to have a stimulant-profile. Brian Kean and spoke about the dangers inherent in the
practice of diagnosing children. He presented a critical review of the
Multi-modal Treatment Approach study noting the bias towards medication in its
effects vs. behavioral treatments. He reported that while
behavioral treatments may appear to be more expensive than medication,
medication alone often has no impact. The afternoon plenary sessions were started by Dr. Robert
Foltz. He brought considerable levity to his in-depth review of the
diagnostic dilemma of Bipolar, ADHD and Conduct Disorder labels. He noted
that between 70 to 90 percent of bipolar youth have at least one additional
Axis 1 diagnosis and he discussed the phenomenally high rates of symptom
overlap. He also spoke about Standard of Care issues and the Texas
Medication Algorithm Project, or T-MAP, presently being expanded for use
throughout the Dr. Breggin presented next and spoke to the issue that
functional differences are not pathological and that one?s body will change as
a function of one?s external world. Drug induced brain changes are really
pathological reactions yet they are being called ?improvements.? Bruce Levine presented an intense plenary session regarding
?common-sense solutions for disruptive children.? Noting that often times
people equate being ?different? with being ?bad?, he observed that too
frequently simplistic behavior explanations are offered for complex issues.
He noted that sometimes kids become compliant because they no longer care
that someone is or is not caring about them. Dr. Levine delineated seven
areas (eg, powerlessness, absence of attention, bored, low self-esteem,
etc) which would be the major factors in producing acting-up
behaviors. On Sunday, Dr. Breggin reconvened the conference by
giving a brief review of ICSPP?s history. Then Dominick Riccio presented the view that family therapy
ought to be the treatment of choice for children. He believes that there
is no such thing as ?good? or ?bad? parents. Rather, there are parents
who have more or less talents and capacities that they can use to help the child
negotiate his/her development. He presented the concept of parent as the
child?s earliest ego defense in that the parent defends and protects the child
not only vis-a-vis the environment but also from his/her own impulses. Kevin McCready, in an energetic presentation, discussed the
internal psychic environments of the child and of the therapist. He spoke
about the changed roll of the mission of the school as it moved from education
of a few through mandatory school attendance and into the age of standardized
curriculum and the oft used classification, Learning Disabilities. He
noted that allopathic drugs really only do one of two things: they stimulate or
they suppress. He commented that the laws of physics and chemistry do not
alter simply because the FDA or a drug company say so. David Stein, in a lengthy plenary session, presented his drug
free program and highly practical treatment approach. Video excerpts
exemplified his benevolent ?being-in-charge? program with its behavioral and
cognitive components. Judging from their remarks of the conference participants,
the two days were experienced as rewarding and useful both in the range of
topics covered and as a result of the interspersed small group sessions
and refreshment, lunch, and supper breaks which allowed for collegial
interactions. The small group sessions spaced between the plenary
sessions allowed for an exploration of each set of recent presentations in
greater depth as well as for personal sharing and discussion. __________________________________________________________________ BIASES IN THE TEACHING OF PSYCHOPATHOLOGY Jeffrey
Lacasse
When I was a MSW student, I took psychopathology from a bright young professor
who taught the class almost exclusively in terms of the Diagnostic and
Statistical Manual of Mental Disorders (DSM). While our class learned the
fundamentals of diagnosing via DSM, the limitations of DSM were not presented,
and related issues such as biological etiology of and the efficacy of
medications were presented from the conventional medical model. When I asked a
question about the views of Thomas Szasz, the professor exclaimed, ?Oh, he?s
crazy!?, apparently unaware of the ironic nature of her remark.
Rather than assuming that all psychopathology classes were equivalent to my own
experience, Tomi Gomory and I conducted a research study to assess the state of
psychopathology education in social work. In academic year 2001-2002, we
collected 71 syllabi representing psychopathology courses from 58 different
schools of social work, including 23 of the Top-25 schools as listed by U.S.
News and World Report?s annual ranking system. We then analyzed the syllabi to
see what sort of critical information was presented, as measured by class
readings. Did they simply present the DSM paradigm as factual, or did they
present the counter-evidence, much of it authored by academics involved in
ICSPP?
Students were generally not exposed to critiques of ?mental illness? or
the DSM medical model; less than 6% of classes require a reading by Thomas
Szasz, Thomas Scheff, or other critics. The reliability and validity of the DSM
has been strongly critiqued (most notably by social work professors Stuart Kirk
and Herb Kutchins), but less than 10% of courses required readings that exposed
the empirical problems with DSM. A majority of the courses included some
bioreductionistic content claiming that mental disorders are the result of
malfunctioning biology, but only 7% of the courses required any relevant critiques.
Finally, medications were portrayed almost unanimously in a positive light,
with only one course requiring a reading that focused on their negative
effects. In looking at ?Suggested Readings?, we found the same one-sided
perspective; hence, Listening to Prozac is suggested in several syllabi,
but Talking Back to Prozac is nowhere to be found.
Importantly, we found that many of the assigned textbooks actually misstate the
empirical evidence for the medical model. Some textbooks claimed that
psychiatric medications correct chemical imbalances in the brain, that the
interrater agreement for DSM diagnoses is above 80%, and that ADHD is caused by
a lack of glucose metabolism! Disturbingly, it appears that many social work
students- even those who are well-intended and work hard to earn an ?A? in
their psychopathology class- may receive their graduate degree without ever
having been exposed to the important critiques of mainstream mental health.
Of paramount importance to the ICSPP mission is the dissemination of research
that is congruent with psychosocial solutions for human problems. In social
work at least, it is fairly clear that this research is not being taught in
psychopathology courses. On an individual level, we should consider that our
fellow clinicians may believe in the medical model not because they have made a
thoughtful decision based on a balanced presentation of the evidence? but
instead, that they may never have been exposed to alternatives to the
mainstream medical model at all. Lacasse,
J.R., & Gomory, T. (2003). Is graduate social work education promoting a
critical approach to mental health practice? Journal of Social Work Education,
39(3), 383-408. If
you would like a reprint of the summarized article, please email jeffreylacasse@comcast.net. __________________________________________________________________ The ?Science? of Psychopharmacology? Report from a
Five-Day Seminar Victor D. Sanua, Ph.D. Summary of an article published in Ethical Human Sciences
and Services, Volume 5(2), 2003, pp. For about 20 years, I have written numerous articles and book
chapters critical of the medical model, arguing against the use of
psychopharmacological agents for the treatment of mental disorders and
indicating that psychotherapy was mostly neglected. My publications were based
on my reading of the psychiatric literature. I never took a seminar of some
significance on psychotropic drugs. The opportunity to do so presented itself
when I received a brochure from a prestigious medical school, advertising a
seminar on psychopharmacology. I should mention that I was also highly
critical, in several publications, of psychologists who want to obtain
?prescription privileges.? I admit that I had never been one hundred percent sure that
it was reasonable to criticize the value of psychotropic drugs altogether. I
reasoned that a reputable seminar by practicing/research psychopharmacologists
would provide me with a portrait of the best scientific justifications for
clinical psychopharmacology. In the spring of 2002, I therefore attended the
seminar on the subject and this seminar was instrumental in eliminating the few
doubts I had about the scientific value of psychotropic drug treatment. The seminar was given for
five consecutive mornings. We had two instructors, both had a good sense
of humor and their contributions were sprinkled with humorous remarks, such as
the following: ?Disruption of sex by drugs? we have no answer. What to do about
it? Use Viagra?; ?Sertraline causes sexual dysfunction. It?s a difficult price
to pay, but it helps to sleep and forget about sex.? The first day was
devoted to neurobiology. Although one of the instructors prefaced his
presentation by stating that we were ?in the dark ages? as far as knowledge of
brain functioning was concerned, he then repeatedly used the words ?We know??
during the remainder of his presentation. I was planning to take detailed notes, but
realizing that the instructors? remarks were replete with doubts, with ifs and
buts, I realized that these expressions of doubt seemed to stand in sharp
contrast to the portrait usually presented in professional and popular accounts
of psychopharmacology?that of a science ceaselessly making great strides and
accomplishing miraculous cures. I concluded that it would be profitable to
concentrate my notes taking on these doubts as an important but rarely
acknowledged part of the reality of research and practice of contemporary
psychopharmacology. I shall provide here a few categories of
remarks. These doubtful remarks, as well as other statements
relevant to a realistic appraisal of psychopharmacological hypotheses, agents,
and treatment strategies, consisted of about 150 specific statements.
These were later coded into a number of categories. Referring to the Influence of Drug Companies. In
the course of the presentations, I found that the program was financed in part
by grants from one or more drug companies. This became clear to me when one of
the presenters, who tried to answer a question posed by a student, indicated
that he could not be critical of drug companies since the seminar was partially
financed by them. What I was given to understand from other literal and implied
remarks is that the success of a particular drug is based on its marketing and
not necessarily on the benefits that patients would derive from it. Raising Questions with Participants and Asking to
Take a Vote. In many instances, the instructors wished to know about the
attendees? experiences (mostly psychiatrists) in prescribing specific drugs.
?Anybody has experience with that drug?? ?My own experience has not been good,
how about you?? In a few cases, when there was some question about the efficacy
of a drug, it seemed that the problem might be resolved with a vote. ?Depends
on the experience. Shall we have a vote?? However, asking to take a vote was a
purely rhetorical question, and no actual votes were taken. Expressing Doubt or Ignorance, and Acknowledging
Lack of Data. As I have mentioned, expressions of doubt and lack of data were
the most frequent types of statements. Examples were ?I do not know the answer,
nobody knows,? or ?Not a great drug. We are fiddling around it, very doubtful
drug.? In my view, these statements characterized the entire seminar.
In conclusion, I found it
noteworthy that in five mornings of expert education about psychopharmacology
as treatment for psychopathology, there was no mention of societal stress,
which could be translated into psychopathology. When instructors used the word
?environmental,? it was only to refer to some organic or physical condition
that might be affecting an individual, such as diet, accidental birth, weather
or seasonal changes. The body was considered to be like a machine, where a
presumed physical condition was disrupting the functioning of an individual,
and the only way to try to fix the problem was to take care of the physical
disruption by drugging the individual. This pure ?medical model?
approach excludes much of psychological science, as we know it. Yet it is
precisely what is being supported by the major efforts of clinical
psychologists in the It is revealing that both
instructors displayed an astonishing amount of candor and doubt about the
available knowledge on psychotropic drug efficacy and safety. One wonders what
these instructors might have said if much of psychiatric education, research,
and perks were not funded by pharmaceutical companies. The psychopharmacological
approach can cause very serious problems in individuals who take psychiatric
drugs and probably most of the benefits derived can arguably be attributed to
the placebo effect. As a psychologist, I find it distressing that my own
professional colleagues want to adopt an unscientific approach to mental
treatment. Psychology has come a long way from its laboratory roots and
philosophical roots to a respectable scientific profession of helping people
with psychological skills. Let us not sell our professional birthright for a
mess of pharmaceutical pottage. Requests for reprints of Dr. Sanua?s article in
Ethical Human Sciences and Services should be sent to him at ________________________________________________________________________ Prescription
Privileges for Psychologists Ron
Schlossberg
Over the last decade or so, there has been a great push by clinical
psychologists to obtain prescribing privileges. Arguing that, like psychiatrists,
they daily treat patients taking psychotropic medications, and share the same
clinical setting & knowledge, psychologists and their associations are
filibustering state legislatures around the country in an attempt to change
laws regarding the right to prescribe. Some schools and professional
organizations have started programs accredited by the American Psychological
Association that offer psychologists advanced training in psychopharmacology,
preparing them for prescribing privileges. (Two programs exist in right here
where I practice in
Recently the
Now if psychologists did get prescribing privileges, how do you think the trend
in treatment might develop? Let's see. I can earn twice as much money if I
hardly talk with my patients & prescribe some anti-depressants, or I can do
psychotherapy for an hour, & make less than half as much. Hmmm. Too
many psychologists, especially newer graduates are not content with their
training in psychotherapy. They are weaned in the era of the bio-genetic,
no-fault, chemical imbalance universe, where a magic pill is supposed to solve
everything, even for infants. Psychologists often ignore their own valid
research that has demonstrated the effectiveness of cognitive & behavioral
change, even when treatment is offered without medication. Perhaps rather than
becoming "wanna be psychiatrists" psychologists should attempt to
mount an effective campaign educating the public to the proven benefits of
psychotherapy, and unite to stop managed care from devastating their
compensation!... I know that just makes too much sense, and why make sense when
you can easily, and mindlessly make more money. All that being said, taking
advanced courses in psychopharmacology for psychologists surely has a degree of
merit. It adds expertise, helps facilitate communications with medical doctors,
and over-all makes for a more well rounded, clinician. . But as far as
prescribing is concerned, if psychologists are going start prescribing in a
similar fashion as psychiatrists.., who will talk to the patients!? Dr.
Ron Dr.
Ronald J. Schlossberg is in private practice in ________________________________________________________________________ Notices If
you have room available in the newsletter you might notify people that I have
established a business (Psychotherapy Centers International - PCI) whose purpose
is to partner with other professionals to fund, develop and support the
establishment and operation of psychotherapy clinics replicating the ________________________________________________________________________ ICSPP Website The
ICSPP website www.icspp.org has been
steadily growing since it?s inception one year ago. We now have 11 menu items
and 39 individual pages. The site is receiving approximately 600 to 700
hits a week and has been registered with 20 of the most popular search engines
including Google, Alta Vista and Lycos. The
menu items are as follows: Home
? ICSPP mission statement About
ICSPP ? history and accomplishments of the organization Board
of Directors ? lists our current board and executive director Position
Papers ? papers by members stating organizations position Publications
- books, articles and presentations by ICSPP members
- books and articles recommended by ICSPP members Conference
? upcoming ICSPP conference information with link to registration form Links
- links to websites run by ICSPP Members In
the Media ? media articles relevant to our mission Newsletters
? ICSPP Newsletters online in their entirety ICSPP
Journal ? link to Springer Publishing with ordering information Membership
Info ? membership form and specifics on how to become an ICSPP member Some
ideas under consideration include a page with psychiatric drug facts, some of
Dr. Breggin?s writings and more ICSPP Position papers. This
is the ICSPP website which means that it is to represent the organization. I
would like everyone to feel free to share their ideas and make suggestions on
what you would like to see. Also, if you have website experience you would like
to share or just want to help out, please let me know. Take
a good look at the site, www.icspp.org, and
add your input. Andrew
Levine AndrewL2@optonline.net
(preferable communication method) 914-633-1905
(please use only if you have no email access) ________________________________________________________________________ Editorial:
The Future Directions of ICSPP
I am grateful to all those who have contributed in this and past newsletters to
my challenge to the membership for articles that point in the direction of a
field free of any vestiges of the medical model. Some of these articles express
anger and disappointment at aspects of both the bio-psychiatric and
psychosocial models of ?therapeutic? intervention into the live of those
seeking help from the psychiatric profession. Some describe the manner in which
their own work manages to overcome the intellectual and moral inadequacies of
the medical model in all of its various manifestations. But few, if any, have
described a philosophical and theoretical justification for our extrication
from the so-called mental health field. It is my own goal to create a
conceptual alternative to the very ideas of ?mental health and illness;? one
that explicates a broad intellectual, scientific, and moral alternative to the
current ideas now dominating our field and one wide enough to encompass and
integrate much of the theoretical fragmentation currently defining professional
life in our society. By discussing the philosophical and theoretical, ways are
always found to move from the abstract to the practical and make our work with
our ?patients? more rewarding and effective. I believe that even it remains
impractical to leave the ?house of cards? that has been our uneasy shelter and
replace it with a sturdy structure of which we can all be proud, such
discussions are important both on an intellectual and practical level. I believe that ICSPP should continue to oppose and debunk the
activities and myths of the bio-psychiatrists and their masters in big pharma.
Ours is perhaps the only organization that takes a strong and consistent moral
stand, backed up by the best in scientific logic, methodology and evidence,
against the propaganda, questionable research practices and devious advertising
that threaten to turn our citizenry, en masse, into drug addicts. ICSPP?s
current course was charted by its founder, the brilliant, indefatigable, clear
sighted Peter Breggin, M.D. I am late to ICSPP, but I join many other members
who have difficulty putting into words their admiration and gratitude for Dr.
Breggin?s continuing leadership in seeking to change the current disastrous
course of mainstream psychiatry. (I use the word psychiatry to include what is
termed clinical psychology, social work and all other words allied with the
so-called mental health field.) However, I feel fortunate to recognize, in addition to Peter
Breggin, another important individual in moving our field in other, more moral
and scientific directions and that is Thomas Szasz, M.D. I feel strongly that
many ICSPP members only give lip service to Szasz?s ideas, expressed in a large
and robust series of books and articles, that suggests that the continued use
of terms such as mental illness or disorders, health, diagnosis, and therapy
employ an incorrect metaphor that is in desperate need of change. Many members
seem resistant, if not frightened, for one reason or another, to explicate the
full philosophical and practical implications of the scientific, moral,
political and economic project contained in such classics and ?The Myth of
Mental Illness,? ?The Myth of Psychotherapy,? and ?The Manufacture of Madness.?
To paraphrase R. D. Laing, we see the world differently than the folks living
in the house created by big Pharma but have difficulty in seeing how we see
that same world and therefore fail to build and inhabit our own
dwelling.
In a moving and perceptive article published on line (www.CTVIP) and to appear in the Spring 2004 ICSPP
newsletter, Richard Shulman, Ph.D. laments the current loss of confidence and
confidentiality in today?s psychotherapy. He writes, ?We shrinks are ultimately
responsible for this. Years ago we fought for health insurance coverage to include the problems
for which people sought psychotherapy. Now we are caught in our own lie?therapy
is not medically necessary. Emotional and personal problems may affect people?s
lives powerfully, but they are not diseases of the body.? In short, we continue
to ignore to ignore Tom Szasz?s argument that descriptions are not judgments;
medical judgments concern the functioning of the body while judgments of what
we do, think, say and feel can be nothing else but moral in nature. Where do we go from here? The nature of the newsletter
seriously limits the type of post- Szaszian discussion I have in mind.
Therefore, I am suggesting that a portion of our next ICSPP conference be
entitled ?Therapy as Civics: Therapist and Patient as Citizens.? By examining
our roles from a political and economic perspective and by analyzing the manner
in which our therapeutic theories and techniques might be affecting our
patients in their roles as citizens (and prospective citizens) we might well
begin to go beyond some of the barriers now preventing us from taking positive
action to redefine ourselves as others than ?doctors of sick minds? even as we
complain about playing such roles. The fall 2004 conference is under serious
discussion as this is being written and I hope all of you reading this are
planning to attend. If you are interested in a philosophical and theoretical
discussion from ?outside the box? of mental health conceptualizations, please
e-mail or write me concerning your desires and interests and I will bring them
forward to the conference planners. Thank you for your patience and interest in my ideas
concerning an added direction of ICSPP activity. And now for something less pleasant but just as important:
Many of us are delinquent on our payment of dues to ICSPP. If members continue
to be delinquent they may be removed from the list of those receiving the
newsletter. Other actions may be taken beyond being deprived of this document
but I can?t imagine any punishment worse than not receiving the ICSPP
newsletter. Make out a check now and send it to Bob Sliclen at the address provided
below. Laurence Simon Dep?t of Behavioral Sciences |
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