Sunday, February 7, 2016

The War Over our Minds and We the Victims




This morning I came across a piece from The Guardian titled Psychiatrists Under Fire in Mental Health Battle (more on the wording of this title to come). Tomorrow - Monday, February the 8th - the British Psychological Society's division of clinical psychology will release a statement declaring that "given the lack of evidence, it is time for a "paradigm shift" in how the issues of mental health are understood."

The piece goes on to add, "The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out "reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems", used by psychiatry". 


And furthermore that "There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful."

This is actually nothing new and is all very consistent with the general positions of psychology that I came across three years ago in my big quest to understand why thirty months under psychiatric care failed me so badly and failed tens of thousands of others so badly.

We'll return to this later.



When I'm not studying or writing about disorders such as bipolar or depression or schizophrenia, I greatly enjoy just studying neuroscience, cognitive neuroscience, evolutionary psychology and human behaviour in general. 

I am especially fond of studying the human brain through its evolutionary past and its great similarities to animal brains. It has been established beyond a doubt that the human brain evolved from earlier primate brains (the division began to take place, I believe, some 200,000 years ago) and there remains many essentially identical anatomical structures to that of most higher mammals. 

There are of course some very key differences, mostly in the ability to learn, languages, higher executive functions, more sophisticated theory of mind and so on (to get into the details would be much more than we have time for today), but at our core, we are the same. And research shows that far more signalling traffic travels from the core up to the higher executive functions than the other way around. In other words, the core has more say in our behaviour than our higher executive functions. In times of frustration with and despair for humanity and what we do to each other, I have declared that humans are nothing more than more sophisticated baboons (and for the most part, I still hold fast to that position). 

And if you overlap the various fields of behavioural sciences, you will find remarkable similarities between human behaviour and animal behaviour. And deep in our animal past and throughout human evolutionary history to this day (both in the physical and cultural senses) you will find tribal behaviours, IE: tribalism. 

Tribalism can briefly be defined for our purposes here today as "the state or fact of being organized in a tribe or tribes" or "the behavior and attitudes that stem from strong loyalty to one's own tribe or social group". 

And indeed if we were to take a look at how humans mostly default to organizing themselves, we would see for the most part deeply divided groups or tribes. I was going to list some examples, but the mind reels at the sheer number of them. You see it in politics, sports, nationalism, gender wars, between and within all scientific fields, in virtually every job place, in regions (and even a general list could go on and on). 

So when I started my investigation into anything and everything to do with mental health three years ago, looking at every side and aspect I could, the war between the tribes of psychology and psychiatry became blazingly clear to me. These are two sides - and we're talking at the top levels here, not necessarily at the "front lines" level - have virtually no common ground whatsoever. 
At the time I was very angry with psychiatry (for reasons we needn't get into here but which I very briefly outline in the essays Psychiatry - The Emperor with No Clothes and The Myths of the Benefits of Psychiatric Drugs) so I found myself siding with positions that were against psychiatry (and those remain very well founded reasons).

In his ground breaking book Anatomy of an Epidemic, noted and Pulitzer Prize nominated science writer 
Robert Whitaker recounts the histories of psychology and psychiatry and showed how while they at one time were more similarly trained. However, as "medical treatments" began to be discovered in the 50's that appeared to be effective in treating hardcore cases of schizophrenia and depression (those who'd become disabled enough by their disorders to end up in institutions), the great divide began. As psychiatrists were trained to be closer to medical doctors and were thus able to legally prescribe drugs, their alliance with the pharmaceutical industry began to grow, the list of disorders that would qualify for "medical treatment" began to grow (as listed in the Diagnostic and Statistical Manual) and the rest, as they say, is history (and Whitaker's book is a very good read to get a better understanding of this history). 

Through the 60's and 70's as more drugs promising cures began to hit the market, people began to flood to psychiatrists and doctors to get medications which they were promised would cure their minds. No longer did one need to spend hours on the couch (and thousands of dollars to lie there) to get one's mind in order, a simple and fast prescription would do. Medical explanations for psychiatric or mood disorders that sounded extremely well founded began to hit popular media with impressive descriptions about synapses and neurochemicals and how mental health difficulties were caused by imbalances in these neurochemicals and how drugs corrected the balance of these. Balance your neurochemicals, balance your mind and get on with life. It all sounded so convincing and psychology was pushed more and more aside and were increasingly left out of the "mind biz" and even marginalized and dismissed as quacks depending on "pseudoscience" (which, to be frank, is not something I would argue against).

This outright dismissal of psychology would be a wake up call - and it was a necessary one - spurred general psychology into action and new fields within psychology delved more and more into neuroscience and its related fields to better understand the neurological basis for human behaviours, a process that roughly took place from the 90's on (though of course there were beginning roots preceding that time). Psychology began to fire back and question the scientific validity of the psychiatric and pharmacological approach to healing the human mind. 

It was the summaries of psychology's findings that I began to come across three years ago as I worked to understand why psychiatry and pharmacology was failing so badly. 

As I looked more and more into factors that would lead to mental health breakdowns, I found all kinds of psychological, societal, socio-economic factors involved (and have begun a series of essays outlining those which can be found in the Table of Contents and Reading Guide). 

Further in the press release reported in that Guardian piece, it goes on to say that "
there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse". 

That is a rather simple and short list but a look into any mental  breakdown involving or stemming from anxiety and depression to schizophrenia to bipolar will indeed find those or other psychological factors running through every case. This has been the position this blog has taken since I began coming to similar conclusions in the summer of 2013. And this is what I found when I looked into why psychiatry and pharmacology were failing so many people - psychiatry inexcusably overlooks so many factors involved in human lives and reduced all their treatment protocol to merely prescribing often dangerous and addictive psycho-active drugs. 

So this newly stated position of the British Psychological Society (and the American Psycholigical Association's position is very similar) would appear to be very affirming of the Taming the Polar Bears position, right?

Well, wait, not so fast, for it is not so simple (nothing ever is, I'm afraid).

I spent a good deal of 2013 pounding away at psychiatry and the pharmacological approach (as evidenced from some of my posts of that period). As well, I spent the first half of that year vehemently denying mental illness, at one point even declaring the concept of mental illness a "myth". What I desperately wanted to believe, however, was that 
I wasn't "mentally ill". 

However, as I studied science, I had to adhere to the principles of science and make sure I did not succumb too much to confirmation bias and therefor I always tried to keep an open mind to opposing views and evidence and indeed I kept in my circles of sources members of what I'll refer to as "the other side". I read countless stories recounting the anguish of depression or bipolar and how drugs had helped them. This, I found, could not be ignored. Some of my best sources of science held to the position of pharmacological treatments and studies they cited could not be ignored, either. 

At the same time, the thing that I could least ignore was my own continuing breakdowns. 
Something was clearly going on to cause my own disordered mind (I think I have some very credible ideas which I am furiously trying to get outlined and written down). 

And what I especially could not ignore was that while various psychology societies and associations could convincingly launch well founded attacks on the validity of pharmacological psychiatry's approach to defining and treating mental health disorders, I couldn't help notice 
they didn't seem to be coming up with any kind of effective definitions, explanations and treatment protocols either

Looking long and carefully at all sides and angles involved in psychiatric and mood disorders led me to a conclusion and position that I have wished to write about for about two years now but until now couldn't quite find the right foundation and with tomorrow's pending announcement from the British Psychological Society, I think the time has come. 

For this, my dear Polar Bears readers, is the truth of what's going on in mental health - psychology and psychiatry are two polemically opposed tribes in a titanic battle over the same territory. 

And that territory, people, is our minds. And we, people, are the battlefield. And we, people, are the victims. 

In truth, neither of these two tribes really gives a shit about us. They're too locked onto their battles with the opposite side to even see us, let alone care about us. They are generals in ivory towers pushing pieces around on a board. They are two armies at war. And as in any war, there are victims on the ground that the generals cannot see. 

While I spend an enormous amount of time studying and researching and searching for clues and answers, I also have spent and continue to spend a good deal of time in "the trenches". I talk to people on the streets, I talk to others fighting disorders, I have talked to dozens of people in psychiatric hospitals and I have talked to dozens of people I have met through this blog.

And quite frankly, I don't see either psychology or psychiatry helping 
any of us as they war away in their baboon like territorial battle over our minds. The overwhelming evidence I found was that neither of them really seemed to understand what was going on and why or, worse yet, know what to do. 

And we the victims continue to suffer in ever increasing numbers. 

While to attack psychiatry and come out and boldly declare that "
current psychiatric diagnoses such as bipolar and schizophrenia are useless" seems reasonable from psychology's point of view, to do so without offering any kind of scientifically valid alternative is, well, not only utterly and absolutely useless itself, it's outright irresponsible and dangerous. 

For while these high and mighty generals ensconced safely away in their ivory towers can easily launch their verbal missiles at one another, without supplying effective alternatives to the "troops" on the ground (psychologists and psychiatrists) who are dealing with the mounting numbers of victims (us), they serve only themselves. 

And meanwhile the bodies literally continue to stack up (suicide numbers and tens of thousands of others who suffer mentally and end up dying of overdoses or slow deaths from substance abuse) and almost literal refugees who have nowhere to go (those of us who do not die, but who are also not able to effectively get back into society or those who must hide their conditions and suffer silently because they are too ashamed and confused to seek treatment). 

When I first began to break down in the summer of 2008 and began to think about seeking treatment, what I encountered most was complete and utter confusion and no clear path to finding understanding and treatment. Some people swore up and down about this, others swore up and down about that. So I did nothing until I completely broke down and was hospitalized in the summer of 2010.

And this confusion is what I see over and over and over again in countless cases while both psychology and psychiatry, in their blinkered war with each other, are blind to the confusion we must endure with many ultimately ending up dying as a consequence or at the least must continue with near unbearable suffering. Any objective and broad look at the current mental health situation would tell you this. 

So what do I think is the answer?

In truth, it is not conclusively known at this point what causes any disorder. While psychological factors are unquestionably important in 
triggering behavioural changes and symptoms, it would be entirely incorrect to say that they are the root cause either. Evidence is mounting for key yet complex anatomical differences in brain structures as being the underlying basis for most disorders. Neurobiological changes and physiological changes absolutely occur in the brain and the body in both long term and short term mental health cases from depression to bipolar to schizophrenia to anxiety to various compulsive disorders. 

So to take an entirely psychological approach is not correct either.

Furthermore, at this time, tens of millions of people depend on the current psychiatric definitions of disorders and pharmacological treatments, yours truly to an extent as well (while I do not rely on medications, understanding that I am bipolar absolutely helps me deal with how my mind works, enabling me to cope with it. As well, a medical designation is the basis for the pension I rely on, without which I would have absolutely no means of supporting myself. This is also the case for thousands of others like me). And while I remain opposed to the general position of psychiatry and its pharmalogical approach to treatment, t
o just suddenly declare the psychological position the "winner" and pull this rug out from underneath these millions of people without a vast new infrastructure to take its place would be utterly disastrous and unspeakably cruel.

So as of now, psychology can offer nothing concrete in ways of understanding and diagnosing disorders, let alone any kind of treatment and care infrastructure. 

Yet to only continue on the same path of the pure psychiatric course is clearly not working either. 

So what to do?

This is the approach I believe may be best. 

If you study drug treatment, it is undeniable that drugs will show short term improvement and stabilization for great numbers of people (though not all). While it is far from perfect, for many it is absolutely necessary. 

Where drug treatment demonstrably falls short or fails is in long term results.

So what if we were to look at psychiatry and psychology this way?

What if we were to think of psychiatry as the mental health equivalent of emergency rooms and short term hospitalization? Just as with a medical emergency, an acute mental health crisis case would go to the emergency room (the infrastructure for this is already in place) and drugs would be administered to stabilize the patient. Some short term hospitalization and further short term drug treatment may also be necessary. 

Then what if we were to think of psychology as the rehab part of the equation? Once the patients were stabilized, it would be up to psychology to understand and treat the root causes and put in place long term  mental "rehab" strategies along with helping to facilitate perhaps the long term lifestyle change or adaption strategies. 

And I have seen enough evidence to suggest that this is indeed the best long term course that produces the best long term results. 

What I strongly and passionately believe is that it's time for these two sides to put aside their baboon like territorial battle and begin to function more like the highly advanced humans we can potentially be and work in better harmony for us. 

For while there are a great number of reasons for our suffering, the absolute 
#1 reason I found in all my research is the confusion resulting from this inexcusable and, frankly, immature battle between the fields of psychology and psychiatry over our minds and mental health. 

In future pieces, I hope to outline clearer strategies for negotiating this mess and I will try to provide links to other sources that help with similar strategies. 

While I obviously strongly believe the understandings of the mind and that strategies for change I teach in 
Taming the Polar Bears can work for or greatly benefit anyone, it would be dishonest of me to believe or declare they were the only way. People are enormously varied and what works for one may not necessarily work for the other. What our core beliefs are will greatly affect what may work and how (something I briefly outlined in the essay In Praise of Quick Fixes).

At this point in time I don't think we can trust the institutions of psychiatry and psychology; they are just too far removed from us as people, as humans, as individuals. This is not to say all members of these societies (in the organizational sense of the word) are bad or that perhaps one could find someone from either profession who may provide some useful help, but the odds, I must frankly say, are against it.  

If you are reading here it is quite possible that you too are in some way a victim of this battle over our minds and the resultant confusion and lack of clarity over what to do. However, dear reader, it is possible for you to make it through, there 
are ways. 

It takes a lot of bravery and personal responsibility but I created this blog and contents to give you some guidance and something to work with. I'd wished to do more, but in the end it was all I could do. 



2 comments:

  1. I think both psychiatry and psychology reflect the culture they work within and in the US there appears to be a far greater desire for biological explanations than in Europe. I think generally the two professional groups work much more closely in Europe. Among the more favoured explanations of psychosis is one that suggests that life stressors overload a persons coping resources in a person who has a particular sort of genetic vulnerability. This then suggests that both medical and psychological interventions can be useful, it even implies that if someone is identified as at risk helping them develop coping skills might help prevent the onset of a psychosis. These ideas provide a good rational for stressing the importance of engagement with the client and involving them in decision making, it helps to provide explanations for their experiences and is generally less pessimistic about outcomes. Its difficult to escape the history of how people were treated or indeed their experiences but it is happening. Its sometimes very difficult to produce good quality evidence when it comes down to human experience and the problems in the science applied to mental health are real and widely acknowledged. However sometimes how people are treated has a powerful moral dimension which is also a type of evidence.

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    1. That is terrific additional insight and commentary, George. Thank you.

      I quite agree with your view of psychosis (for reasons too long to get into here but which I will eventually address in a dedicated post).

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