by William Schultz, Doctoral Student, Minnesota School of Professional Psychology

The first full week of October (October 4^th – 10^th) is “Mental Illness Awareness Week” (MIAW). The primary purposes of MIAW are to fight stigma, provide educational material to the public, and to push for better mental health care. The National Alliance on Mental Illness (NAMI) has energetically promoted MIAW. This isn’t surprising since NAMI’s goals are to fight stigma, raise awareness, and provide education about “mental illness” to mental health patients, the public, and policy makers (NAMI, 2015a). But NAMI’s efforts may, in fact, be making the matter worse.

No doubt the stated NAMI goals are important. Millions of individuals suffer from significant emotional and mental distress (often called mental illness or psychological disorders – terminology I dislike but will use for clarity in what follows). Lack of awareness, as well as stigma surrounding psychological disorders, contribute to these individuals not seeking the assistance of mental health professionals (Bharadwaj, Pai, & Suziedeltye, 2015). This is unfortunate because many forms of psychological disorders can be significantly diminished through treatment. For example, Khan, Faucett, Lichtenberg, Kirsch, and Brown (2012) conducted a meta-analysis of hundreds of studies. Their meta-analysis found that the depressive symptoms of patients who participated in psychotherapy decreased by about 50%. On the other hand, the depressive symptoms of patients on a waiting list only decreased by about 10%. This finding led Khan et al. (2012) to argue “engaging in treatment is critical to improvement” (p. 9).  

Since treatment is important, and reducing stigma is thought to increase treatment seeking, it’s not surprising that for some time mental health advocacy organizations have done their best to try to reduce stigma. But NAMI's misstep is to promote a biological etiology of psychological disorders (Corrigan & Watson, 2004). The underlying idea behind this approach is that there will be less blame associated with psychological disorders if patients and the public conceptualize psychological disorders as biological illnesses (Corrigan et al., 2000). For example, if biological etiologies of depression were embraced, the public may view someone experiencing depression as chemically-imbalanced or genetically predisposed instead of weak willed or lazy. It’s thought that stigma can be diminished by decreasing or removing the element of moral blame associated with being weak willed or lazy. 

NAMI has a long history of ostensibly fighting stigma by claiming that psychological disorders are a biological, medical illness like cancer or diabetes (Angermeyer, Holzinger, Carta, & Schomerus, 2011; Deacon, 2013; Kvaale, Haslam, & Gottdiener, 2013; Lebowitz & Ahn, 2012). For example, a study by University of Michigan researchers found that NAMI’s web site information about depression emphasized biological etiologies (Hansell et al., 2011). While depression treatment centers, universities, and government websites generally provided approximately proportional descriptions of biological and psychosocial causes of depression, NAMI’s website – like pharmaceutical company websites -- focused much more on biological causes. While treatment centers, universities, and governments provided balanced explanations or even explanations that emphasized psychosocial causes, “The NAMI Website, for example, showed a 9:1 ratio in biological to psychosocial content about depression” (Hansell et al., 2011, p. 387). This sort of finding probably goes a far way of explaining why the first treatment option listed for the majority of the mental health conditions on NAMI’s “Fact Sheet Library” is medication (NAMI, 2015b) – though Hansell et al. (2011) suggested that the emphasis on biological etiologies “may in part reflect NAMI’s close relationship with pharmaceutical companies” (p. 387). 

If an accurate reflection of reality, NAMIs approach seems coherent. That is, if emphasizing biological etiologies can diminish stigma and diminishing stigma can lead to improved treatment outcomes, then NAMI’s approach seems to have some plausibility. 

However, NAMI’s perspective on psychological disorders is troublesome for at least three reasons:

First, biological etiologies of psychological disorders do not necessarily decrease stigma. In fact, a large body of evidence suggests that biological etiologies of mental illness can increase stigma associated with many psychological disorders (Schomerus, Matschinger, & Angermeyer, 2014; Speerforck, Schomerus, Pruess, & Angermeyer, 2014). One prominent explanation for this finding is that although biological etiologies may diminish moral blame, they increase the perceived dangerousness and difference of those experiencing mental illness.  

Second, emphasizing biological etiologies implies that biological interventions (e.g., medications) are the preferred treatment (Deacon, 2013; Kemp, J. J., Lickel, J. J., & Deacon, 2014; Read, Cartwright, Gibson, Shiels, & Magliano, 2015). This is concerning because substantial evidence suggests that very often medications do not provide significantly superior treatment benefits for psychological disorders when compared to psychotherapy (Cuijpers, Sijbrandij, Koole, Andersson, Beekman, & Reynolds, 2013; Harrow, Jobe, & Faull, 2012; Khan et al., 2012) and medications have a long list of negative effects, some of them very serious (Andrews, Thomson, Amstadter, & Neale, 2012; Kirsch, 2014; Moncrieff, 2009; Moncrieff 2013).

Third, emphasizing biological etiologies can have significant clinical impacts. Individuals who endorse a primarily or exclusively biological etiology of psychological disorders have increased prognostic pessimism, probably because they’ve accepted an essentialist account of their identity which leads them to believe they have little ability to modify their subjective experience (Lebowitz, 2014; Schultz, 2016). Increased prognostic pessimism is an important clinical factor because individuals’ expectancies for improvement is a significant contributor to their actual improvement. Individuals who expect to do better, do better (Constantino, 2012). 

To sum up, MIAW has a great chance to educate the public about the prevalence, causes, and treatment options for psychological disorders. I hope this short piece shows that the perspective adopted by NAMI is not comprehensive and probably harmful to clients. 

But what about stigma? Well, as I wrote previously: “… a biological understanding of psychological disorders is not the only way to combat stigma. We can adopt a compassionate attitude toward those struggling with [psychological disorders] even if we don’t also accept the view that their [psychological disorders are] biologically determined. For example, individuals [with psychological disorders] may simply not know other ways to manage their emotions or they may be dealing with a variety of stressors which overwhelm their ability to cope in a more adaptive way. Neither of these views suggests that the proper attitude is to judge and chastise individuals…as being weak willed” (Schultz, 2015).

References

Andrews, P. W., Thomson Jr, J. A., Amstadter, A., & Neale, M. C. (2012). Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good. Frontiers in Psychology, 3, 117.

Angermeyer, M. C., Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. The British Journal of Psychiatry, 199(5), 367-372.

Bharadwaj, P., Pai, M. M., & Suziedelyte, A. (2015). Mental Health Stigma (No. w21240). National Bureau of Economic Research.

Constantino, M. J. (2012). Believing is seeing: an evolving research program on patients' psychotherapy expectations. Psychotherapy Research, 22(2), 127-138.

Corrigan, P. W., River, L. P., Lundin, R. K., Wasowski, K. U., Campion, J., Mathisen, J., Goldstein, H., Bergman, M., Gagnon, C., & Kubiak, M. A. (2000). Stigmatizing attributions about mental illness. Journal of Community Psychology, 28(1), 91-102.

Corrigan, P. W., & Watson, A. C. (2004). At issue: Stop the stigma: call mental illness a brain disease. Schizophrenia Bulletin, 30(3), 477-479.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons. World Psychiatry, 12(2), 137-148.

Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846-861.

Hansell, J., Bailin, A. P., Franke, K. A., Kraft, J. M., Wu, H. Y., Dolsen, M. R., Harley, V. S., & Kazi, N. F. (2011). Conceptually sound thinking about depression: An Internet survey and its implications. Professional Psychology: Research and Practice, 42(5), 382-390.

Harrow, M., Jobe, T. H., & Faull, R. N. (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine, 42(10), 2145-2155.

Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals' perceptions of their depressive symptoms. Behaviour Research and Therapy, 56, 47-52.

Khan, A., Faucett, J., Lichtenberg, P., Kirsch, I., & Brown, W. A. (2012). A systematic review of comparative efficacy of treatments and controls for depression. PloS one, 7(7), e41778.

Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33(6), 782-794.

Lebowitz, M. S. (2014). Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences. Clinical Psychology: Science and Practice, 21(1), 67-83.

Lebowitz, M. S., & Ahn, W. K. (2012). Combining biomedical accounts of mental disorders with treatability information to reduce mental illness stigma. Psychiatric Services, 63(5), 496-499.

Moncrieff, J. (2008). The myth of the chemical cure: A critique of psychiatric drug treatment. New York, NY: Palgrave Macmillan.

Moncrieff, J. (2013). The bitterest pills: The troubling story of antipsychotic drugs. New York, NY: Palgrave Macmillan.

National Alliance on Mental Illness. (2015a). About NAMI. Retrieved from https://www.nami.org/About-NAMI

National Alliance on Mental Illness. (2015b). Fact sheet library. Retrieved from https://www.nami.org/Learn-More/Fact-Sheet-Library

Read, J., Cartwright, C., Gibson, K., Shiels, C., & Magliano, L. (2015). Beliefs of people taking antidepressants about the causes of their own depression. Journal of Affective Disorders, 174, 150-156.

Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2014). Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychological Medicine, 44(02), 303-314.

Schultz, W. E. R. (2015) Binge eating and genetics. Retrieved from https://www.madinamerica.com/2015/08/binge-eating-and-genetics/

Schultz, W. E. R. (2016). Neuroessentialism: Theoretical and clinical considerations. The Journal of Humanistic Psychology. Accepted for publication.

Speerforck, S., Schomerus, G., Pruess, S., & Angermeyer, M. C. (2014). Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: Is the concept of a chemical imbalance beneficial?. Journal of Affective Disorders, 168, 224-228.

by Rick Winking

We received word here at ISEPP that one of our favorite members had passed. Ben Hansen, alias Dr. Bonkers, ended his struggle with bladder cancer on September 14th. He was 60 years old and fought the good fight until the end, refusing any medication and dying pain free and peacefully at home with the help of Hospice of Michigan.

We all know that psychiatry is a joke. We know that scientifically, they don’t have a leg to stand on. It was Ben Hansen and his Bonkers Institute for Nearly Genuine Research that really helped put this in focus for us. He used past ads for medications from psychiatric journals to point out the absurdity of psychiatry's past. He used current ads and articles to show that nothing has really changed in the past 100 years…..old wine in new bottles or as they say in the military, “SSDD.”

I have been a student and critic of psychiatry for over twenty years and thought I knew a lot. Then along comes Dr. Bonkers. I found myself marveling at some of the stuff he dug up and thinking to myself “Wow! These guys have a history of this that is even crazier than I thought.”

Thorazine for Hiccups? With Partnership for a Drug Free America getting psychiatrists to look for drug abuse in their patients and help stop America’s drug problem? Drugs for deviant sexual behavior? Dr. Bonkers found all of this.

Noam Chomsky defined Anarchism as “A tendency in the history of human thought and action which seeks to identify coercive, authoritarian and hierarchic structures of all kinds and to challenge their legitimacy – and if they cannot justify their legitimacy, which is quite commonly the case, to work to undermine them and expand the scope of freedom.”

Using this definition, Ben was one of my all-time favorite anarchists. I would refer doubters to the Dr. Bonker’s web site and their response was usually one of “These ads and articles can’t be real!” …..and another hole was poked in the psychiatric Zeppelin. He did not live long enough to see the Zeppelin crash and burn but he most assuredly poked some major holes in it. I was informed that the site will stay up in the future. Let’s keep sending the doubters there.

 Let’s do it for Ben!

Over the past decade, there have been numerous allegations of inappropriate collusion between the American Psychological Association (APA), CIA, and the Department of Defense (DoD) with the intent of molding APA ethics guidelines to allow psychologists’ continued involvement in enhanced interrogations, considered torture under international law. Still, APA leadership stood firm in the face of the mounting evidence against them.

The ISEPP Board of Directors has followed this issue, releasing two public statements (here and here) and joining with Physicians for Human Rights, Psychologists for Social Responsibility, and the Coalition for an Ethical Psychology in public petition to the APA. Last November, the APA finally commissioned David Hoffman of Sidley Austin, LLP, to conduct an independent investigation.This past July, Hoffman’s report was released. It was a bombshell, revealing many deceptive deeds committed by senior representatives of APA, to include the Ethics Director, in order to curry favor with the DoD and the Bush administration. Since its release, some of the senior APA representatives involved have been fired, resigned, or retired early.

With the Hoffman report in hand, the APA Council of Representatives surprised many in August at the annual APA Convention in Toronto when it overwhelmingly passed a resolution that finally banned all psychologists’ participation in any national security interrogations that violate international law regarding cruel, inhuman, and degrading treatment. The only dissenting vote came from the Society of Military Psychology Division representative and former military psychologist at Guantanamo who was one of the DoD representatives colluding with the APA. We wait with cautious optimism for this resolution to be implemented (the caution is because a member-driven referendum with the same ban in 2008 was never enforced by the APA).

In addition to our public statements and petitions to the APA, ISEPP has also been involved in the development of new ethical guidelines intended to supplement APA’s Ethical Principles of Psychologists and Code of Conduct, and to prevent the kind of nightmare revealed by the Hoffman report. In particular, the Coalition for an Ethical Psychology invited ISEPP’s Chairman of the Board of Directors, Chuck Ruby, Ph.D., to represent ISEPP at a workshop on the ethics of operational psychology in Brookline, MA, that took place September 18-20. As a retired military counterintelligence officer and psychologist, Dr. Ruby had been consulted earlier by the Coalition in the development of ideas about the ethics of operational psychology (see Arrigo, J.; Eidelson, R; & Bennett, R (2012). Psychology Under Fire: Adversarial Operational Psychology and Psychological Ethics. Peace and Conflict: Journal of Peace Psychology. 18:4, 384-400.). At the workshop, Dr. Ruby joined with experts from several professions to develop principles and guidelines for operational psychologists. The formal report entitled “The Brookline Principles on the Ethical Practice of Operational Psychology”, was released today to the press, professional organizations, and distributed widely within the APA. 

ISEPP remains committed to continue this fight of bringing psychology back in line with the basic values of do no harm and respect for human dignity.

Chuck Ruby, Ph.D.

In these early hours after Chris Mercer’s mass shooting at the Oregon community college, it would be easy to blame the rampage on “mental illness”. As has happened all too often in the past, news reports zero in on whether the shooter suffered from this fictitious disease (for example, see http://www.cbsnews.com/news/mass-shootings-and-the-mental-health-connection/). Such unjustified analyses and reactions to these terrible events serves as nothing more than a distraction from the actual factors associated with violent behavior and prevents the development of viable policies to make our society safer (See ISEPP Public Statement: The Role of Mental Illness in Violent Behavior). But perhaps more problematic, it also sets up a false dichotomy that certain kinds of people commit these acts and the rest of us are not prone to such violence. It sends us on a crusade to find these defective souls, to brand them with mental illness diagnoses, and then to provide them with “treatment” to rid them of their infection. Screening tools used to identify these people are notoriously in error and result in huge false alarm predictions, meaning that the great majority of those identified would never have committed a violent act. So, thousands and thousands of people, including children, would be subjected to this flawed assessment and then herded into the traditional psychiatric corral and subjected to all its demeaning, dehumanizing, and debilitating harms. Ironically, it is this very process that can actually increase the chances that violent behavior will occur (See ISEPP White Paper: Psychiatric Drugs and Violence). In short, we continue to look for the demon within, rather than the actual causes of violence.

ISEPP's Mary Vieten, Ph.D., ABPP, is expanding her attempts to change the landscape of PTSD treatment. She recently was asked to talk at the Massena, NY Operation Grateful Nation where veterans attended the Greater Massena Ministerial Association. See here for the details.

Mary has been leading the effort of ISEPP's Operation Speak Up in turning the tide toward a humane response to military and veterans who have witnessed the horrors of war. One of her projects is TOHIDU, which is an America Indian word that means peace, mind, body, and spirit. TOHIDU is a week-long retreat that offers non-medical support to our country's warriors. See what's happening at TOHIDU here.

Noel Hunter, Doctoral Student

A recent article in the Washington Post, entitled “Her brain tormented her, and doctors could not understand why.” was a heart-wrenching story of a troubled young woman who suffered greatly in her final years before dying at the young age of 23 due to a reaction to a prescription drug. This story is a haunting example of the all-too-common tragic outcomes of people who suffer from extreme states of human distress. Unfortunately, the Post’s rhetorical tale, which is based on misinformation, extreme reductionism, and a distortion of research, only adds to the tragedy of Ms. Pam Tusiani.

The Post’s first error is in taking as fact the idea that extreme emotions, suicidal thoughts, and seemingly strange ideas and behaviors are “symptoms” of a medical, biological disease. The problem is exemplified in the statement: “What was once thought to be the result of child abuse or a manifestation of post-traumatic stress is now its own complex personality disorder. And it’s deadly”. This statement is somewhat incomprehensible considering that “personality disorder” is simply a label and nothing more. It doesn’t describe a “disease”; it describes a problem. 

At no point does the author express how or why a post-traumatic reaction suddenly was re-conceptualized as a “deadly” disease according to his resources (assuming he has any). In fact, research does continue to show that up to 92% of individuals labeled with borderline personality disorder (BPD) have experienced some kind of childhood abuse¹. In addition, they are more likely to have experienced sexual abuse, specifically, and they have a greater number of perpetrators than people labeled with other kinds of psychiatric diagnoses. Dismissing off-hand the post-traumatic nature of the problem called BPD is an egregious error and not based on the scientific research. Further, the biological evidence the author cites as proof of “disease” (i.e., problems in the amygdala and “fight or flight” reactions) are precisely those that occur in individuals who have experienced extreme, chronic stress and/or trauma such as child abuse. But it must be emphasized that these biological consequences do not cause BPD. They are natural human reactions to intense and chronic stress of any kind. Presenting them as evidence of disease is like saying concussions are evidence that playing football is a disease.

With this in mind, then, one must first wonder what “cure” all the medical doctors are looking for? Have they read the work of Bessel van der Kolk, M.D. or Marsha Linehan, Ph.D.? Have they read any of the extensive studies showing the effectiveness of trauma-focused therapy, dialectical behavior therapy, yoga, meditation, somatic therapies, and others? What is this biological cure so many are seeking? Perhaps they may start by increasing efforts to prevent and ameliorate child abuse.

Second, giving the benefit of the doubt that DSM-defined categories are true diseases that exist in nature separate from the subjectivity of the person making said diagnosis (which is a dubious assumption), the author discusses the case of a young woman diagnosed with BPD, yet goes on to state: “We barely understand a healthy brain, so how are we to understand one haunted by psychosis?” This statement is a glaring error in even the most rudimentary understanding of psychiatric problems, for one would be hard pressed to find a clinician who deemed BPD to be a characterized by psychosis. However, the author may be saved by the fact that DSM-diagnostic categories lack validity and reliability anyways (the Director of the National Institute of Mental Health said so in 2013) and there are, in fact, no distinct lines that can define any one person’s experience completely.

Another error in research reporting is the author’s claim that “The suicide rate is higher for people with BPD than for those with major depression and schizophrenia; about 4 to 9 percent kill themselves”. In fact, the commonly cited estimate for suicide in persons diagnosed with schizophrenia is 10% to 13%, with approximately two to five times that rate attempting suicide^{3, 4}. Additionally, approximately two thirds of all cases of suicide include the occurrence of “depression” ^{5, 6}. The overall message should be that people who suffer, and suffer deeply, are more likely to commit suicide. Why make erroneous comparisons that are not even backed up by resources?

Perhaps the greatest error within this article is the complete disregard for the long-standing iatrogenic effects her so-called “treatment” may have had.  The author’s own statement should have raised huge, waving red flags: “She was on a laundry list of medication”. Many of these that are listed, including Paxil, Prozac, and Zoloft, are known to create an increased risk of suicide, violence, and agitation, especially in young adults and adolescents. Even more importantly, a recent study showed that pharmacotherapy for BPD “is not supported by the current literature” and that “polypharmacy should be avoided whenever possible”, recommending psychotherapy is the first-line treatment for BPD⁷. Another disregarded potential exacerbating factor is the internalized stigma, shame, and helplessness that comes from being told one has a “brain disease” instead of having the source of her pain recognized and addressed. She was in and out of hospitals, an experience that has been shown to directly create post-traumatic phenomena in those with the most severe problems, such as psychosis⁸. Lastly, many of the drugs that Ms. Tusiani was on are also shown to create psychotic experiences. Yet, not once does the author acknowledge or explore these clearly evident possibilities. Even the fact that the young woman died as a direct result of taking the antidepressant Parnate does not lead to an investigation of how this “laundry list” of drugs might have affected her. Instead, the subject is put to rest by blaming it on the fact that the drug was prescribed in a treatment center that was providing unlicensed medical care. Would the outcome have been any better if the center had that license? 

The story of Ms. Tusiani and her fatal experiences with inner turmoil and ineffective treatments is one that should be heard by an audience much larger than that served by the Washington Post. However, her story also deserves to be told with the integrity and fortuitousness of a critical journalist unafraid to ask the important questions. The family of Ms. Tusiani is understandably angered and determined to ensure that others do not have to endure the misfortunes that became their daughter. Such prevention begins by looking at the evidence that stares us directly in the eyes.

References:

1. 1. Zanarini, M. C., Williams, A. A., Lewis, R. E., Reich, R. B., et al. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. The American Journal of Psychiatry, 154, 1101-1106.
2. 2. Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M. (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder. The American Journal of Psychiatry, 147(8), 1008-1012.
3. 3. Siris, S. (2001). Suicide and schizophrenia. Journal of Psychopharmacology, 15, 127-135.
4. 4. Caldwell, C. B., & Gottesman, I. I. (1990). Schizophrenics kill themselves too: A review of risk factors for suicide. Schizophrenia Bulletin, 16, 571-589.
5. 5. Conwell, Y., Duberstein, P. R., Cox, C., Herrmann, J. H., Forbes, N. T., & Caine, E. D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153, 1001-1008.
6. 6. Henriksson, M., Aro, H., Marttunen, M., Heikkinen, M., Isometsa, E., Kuoppasalmi, L., & Lonnqvist, J. (1993). Mental disorders and comorbidity in suicide. American Journal of Psychiatry, 150, 935-940.
7. 7. Francois, D., Roth, S. D., & Klingman, D. (2015). The efficacy of pharmacotherapy for borderline personality disorder: A review of the available randomized controlled trials. Psychiatric Annals, 45, 431-437.
8. 8. Berry, K., Ford, S., Jellicoe-Jones, L., & Haddock, G. (2013). PTSD symptoms associated with the experience of psychosis and hospitalization: A review of the literature. Clinical Psychology Review, 33, 526-538.

Chuck Ruby, Ph.D.

Dr. Thomas Insel, the head of the National Institute of Mental Health (NIMH), has announced he is stepping down after serving in the position for the past 13 years (see http://www.nytimes.com/2015/09/16/health/tom-insel-national-institute-of-mental-health-resign.html). Dr. Insel’s main impact was to reorient the focus of NIMH toward a biological approach to the understanding of mental disorders, especially the serious ones. During his tenure, NIMH’s budget has been about $1.5 billion annually, with the great majority of those dollars going to research on the biology of mental disorders.

Dr. Insel’s appointment to the NIMH, along with his shift in focus, came on the heels of George H. W. Bush’s Decade of the Brain in the 1990’s, that was promised to unlock the mysteries of psychiatric problems by uncovering the biology and genetics of disordered brain functioning. President Obama more recently boosted this focus in his Brain Initiative in 2013, although perhaps too late for Dr. Insel. Nevertheless, this shift in focus was touted as a more scientific approach to diagnosing and understanding brain disorder, bringing psychiatry in line with the other medical sciences like neurology and cardiology.

It was under Dr. Insel’s tutelage that NIMH initiated the Research Domain Criteria (RDoC) program, which is intended to replace the current psychiatric diagnostic system of the DSM series, by building a bottom up system of diagnoses based on brain scan and genetic technology showing dysfunctioning brain biology for each disorder. Dr. Insel launched this program after publicly announcing in 2013 that the prevailing DSM diagnostic scheme was seriously flawed (DSM continues to be used today!).

Despite all the billions and all the rhetoric about how we are almost to the point of unlocking the biological secrets of mental disorder, we still have no reliable or valid biological marker. All we have are pretty brain scan pictures and genetic data showing what we already knew: biology changes, depending on how the body is used. This is true for mental disorders as it is for any human activity, including thinking, imagining, running, singing, and crying. But even with all this research, not one biological marker has been discovered that would enable diagnostic decisions. One would wonder if this is the reason for Dr. Insel’s departure. Have the failed research attempts convinced him to throw in the towel?

Regardless of Dr. Insel’s motivation for leaving, NIMH is left with a problem. It has been assumed the reason they haven’t found the “Rosetta stone” of biological psychiatry is that their research is either underfunded, inadequate, or they just aren’t looking in the right direction. Frequent chants of “we’re almost there!” echo from their halls, but this claim is unjustified. No other scientific research endeavor would continue along such a long line of failed attempts, hoping for the tide to turn “soon”. Other areas of research would have long since abandoned such theories that are not supported by the evidence.

NIMH has overlooked the real reason for not finding the stone: mental disorders (even the “serious” ones) are not brain diseases. In all the decades of scientific research, there has been no reliable evidence that supports the theory of mental disorders as caused by bodily pathology. Therefore, there is neither a disease to diagnose, nor biological marker to find. So-called “mental disorders” or “mental illness” or “mental disease”, whatever interchangeable term is used, are natural human reactions to the vicissitudes of life. Trying to jam these square pegs into the round holes of medicine does nothing but harm people, strip them of their dignity and humanity, and funnel them into a psychiatric pipeline of disability and despair.

The billions poured into brain scan research has acted as a subterfuge. It is like a house built upon a very weak foundation. The house may look impressive, and sell at a high rate. But if its occupants insist on living in it without checking the condition of the foundation, it will soon crumble under its own weight and trap all inside.

Our own David Rose, a Vietnam War veteran, put together this song about his experiences with war trauma. Check it out here.

David says, "I have received over 300 hours of post war PTSD therapy from the VA. As I was leaving my therapist's office following a session, on the way out the door she said, 'David, just don't sit and think about your PTSD so much.' I went home and wrote this two line piece. 'I don't sit and think about my PTSD, my PTSD thinks about me and I sit.'"

One of the alternative therapies David has been involved with is songwriting with OperationSong.org. He used these lines as a foundation for his song and built the rest of the song around it by sharing some of his other PTSD thoughts and experiences. The PTSD warrior on the couch in the video is David.

Al Galves, Ph.D.

A recent edition of U.S. News and World Report highlights the provisions of two bills in Congress that claim to enhance the mental health system in our country. See here for the report.

But a more critical examination of these bills shows us they are both dangerous.

God knows we need to improve our mental health system, especially our ability to help people who are diagnosed with serious mental illnesses¹. One piece of evidence is the following underreported fact: The great majority of people who have shot up schools, workplaces, movie theaters, churches and families have been patients in the mental health system and the system has failed them.

The Federal government is a major source of funding for mental health services, spending about $72,000,000,000 in 2014². Thus, the Federal government has an opportunity to improve the mental health system. These two bills in Congress are designed to improve the system. By far the more important one is HR 2646, the Helping Families in Mental Health Crisis Act. It was introduced by Representative Tim Murphy (R-PA).

If enacted in its present form, HR 2646 will make our mental health system more punitive, oppressive and medicalized. By defunding and downgrading programs that help people recover from the states of being that are associated with diagnoses of serious mental illnesses, the bill goes in exactly the wrong direction. Here is what HR 2646 does:

It increases the scope and breadth of court-ordered (involuntary) outpatient psychiatric treatment by providing funds to states for spreading it and requiring states to adopt such laws by conditioning receipt of Federal funds for community mental health centers on such adoption;

It emasculates the recovery-oriented, consumer-involved initiatives of the Substance Abuse and Mental Health Systems Administration (SAMHSA) by placing SAMHSA under a newly-created Assistant Secretary for Mental Health and Substance Abuse and preventing SAMHSA from establishing any program or project not explicitly authorized or required by Congressional statute.  This puts in jeopardy the efforts to train recovered peers and establish peer specialists as an integral part of the community mental health system, the annual Alternatives conference and the spreading of Emotional CPR;

It terminates funding for the National Empowerment Center and the National Coalition for Mental Health Recovery, both organizations which develop and promote recovery-oriented approaches and the incorporation of recovered peers into the mental health system;

It increases funding for biopsychiatric treatment and research by giving control over the $400,000,000 annual appropriation for community mental health centers to the Assistant Secretary and giving increased funds for brain research to the National Institutes for Mental Health. The bill stipulates that these funds can be used only for "evidence-based practices". This can be used to abandon recovery-oriented approaches which are clearly effective but have not been subjected to rigorous research; and,

It weakens the ability of the protection and advocacy agencies to protect the human rights of persons diagnosed with mental disorders by prohibiting them from "counseling an individual with serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of the individual's caregiver."

Here are some other problems with the bill:

It downgrades and weakens the federal agency most supportive of recovery, peer support and community integration;

It places much more emphasis on medical treatment rather than on supporting the empowerment and recovery of persons through their active participation in their recovery and community;

It promotes a narrow, professionally-focused system of care in stark contrast to current thinking in healthcare which is moving rapidly to implement patient-centered care, shared decision-making and self-management of chronic conditions;

It ignores the significant role of toxic stress and trauma and precludes interventions which have been proven to be effective in helping people who suffer from those experiences;

It will keep people in clinical revolving doors rather than moving forward with their lives; and,

It expands the use of forced treatment which harms rather than helps people.

The Murphy bill, as it is called, reinforces and expands the mainstream standard of care. That standard of care has led to a dramatic increase in the number of Americans who receive Social Security Disability due to a mental illness³. The Murphy bill enfranchises a system of care which uses drugs as the primary modality of "treatment", an approach which harms rather than helps people. The fact that most of the billions of dollars spent by the Federal government on mental healthcare harms rather than helps people is tragic. This bill would make that tragedy even more widespread and entrenched than it is today.

What would a good mental health bill look like? It would close the gap that has been created by the $4,000,000,000 reduction in state funding for community mental health over the past 5 years. It would promote and expand alternatives to the mainstream standard of care such as Soteria-type sanctuary houses, open dialogue approaches, the Hearing Voices Network of support groups, peer-run crisis respite programs, peer bridgers, supportive employment, housing first and peer-directed training such as WRAP, Emotional CPR and Intentional Peer Support.

¹The term "mental illness" is being used in this article in order to facilitate a discussion between people with extremely varied conceptions of what "mental illness" is. There are big problems with the term "mental illness". Although many “mental illnesses” are illnesses in the sense that they impair the ability of people to function well, to live full and satisfying lives, the states of being that are diagnosed as “mental illnesses” are much more than illnesses. They are also wake-up calls, opportunities for learning and growth, numinous experiences of connection with the divine and moves towards reconstitution of selves which have been discounted, abused and traumatized. To see them just as illnesses and disorders is a damaging distortion.

²Substance Abuse and Mental Health Services Administration. (2008). Projections of National Expenditures for Mental Health Services and Substance Abuse Treatment, 2004-2014, Garfield, R.L. (2011). Mental Health Financing in the United States: A Primer. Kaiser Commission on Medicaid and the Uninsured.

³Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. New York: Crown Publishers.

The ISEPP Chairman of the Board of Directors, Chuck Ruby, Ph.D., was interviewed by Ohio's WLJA Radio program called Bedlam in America. It is set to air on Tuesday, August 18th, from 10:00 to 11:30am. After that it will be available via stream at the program's website at https://www.wljaradio.net/bedlam-in-america.html.

Dr. Ruby discussed several issues of importance, to include the recent American Psychological Association's resolution banning psychologists from participating in national security investigations, violence, the problems with psychiatric drugs, the weak foundation of the medical model of mental illness, the invalidity of the DSM diagnostic system, and the NIMH's RDoC program to create a new diagnostic system, but that will be just as flawed as the DSM.

Thanks to WLJA for helping ISEPP get the word out!