I’m split. Part of me wants to do something; the other part wants to relax and think, taking stock of what’s happened and what it signals for the future. Let’s compromise: I’ll write something, something that won’t make sense, but that’s not the point.
It feels like the end of the school year – all your work’s done, there’s nothing left to do after putting all your effort into something that’s now reached its natural conclusion. Feelings of accomplishment mixed with exhaustion, loss, finality but also possibility.
It’s too early to say whether or not I’ve been entirely successful, but the signs are good, even though that’s possibly not the vibe I’m giving off in this. Again, that’s not the point. What I set out to do, I think I’ve achieved. That didn’t come into clear view until late in the process, appearing only gradually and in different forms until, layer upon layer, in the final moments of the whole thing, what I needed to do and why I needed to do it became evident. It finally all made sense.
Last night I could have died. It wouldn’t have mattered. Smashed by a succession of illnesses and severe sleep-loss, it was one of those rare moments when you’re so fucked you realise there’s nothing left to do because you’ve already done everything you set out to do. Your meaning’s been realised and your life’s seen out its course. This never lasts long and it suggests life’s some sort of road with staging posts, not uncomfortable places to be while they last.
This year – this staging post – was always going to be difficult, though. It’s 20 years since I first started having it really tough in life and, though such anniversaries shouldn’t really mean that much, we’re human, and we often replay key moments. Within that were a whole host of more recent memories, clouding my mind even further for not far off a decade. And yet, last night, because of how things had gone, it all made sense, it was all packaged up and put away once and for all.
Different place, this world, now, with a different outlook. The structure I’m putting on these events makes them all look almost pre-determined, as if there’s some great scheme of things, some intelligent design to it all. Maybe there is. I don’t know and I’m not sure it matters. What I do know is that life’s different all of a sudden. I’m still me and the experiences I’ve had are still part of my make-up, but it’s an evolved me where the events have taken on a new meaning and place in life. ‘That Moment,’ my last post, wasn’t what I thought it was at the time. Again, the layers were being revealed as something which would become much more substantial and important to me. Now that post means something different, something better.
I don’t use a lot of the social media I use for the usual reasons. I don’t see that kind of use as serving much of a purpose. Social media at the moment isn’t really going anywhere and we seem to be in some sort of limbo. I’ve also not got a lot to benefit from in building a ‘social media reputation’ or in fostering primarily networked relationships.
Some time ago my usage evolved into me going to the ropes and using social media in a way which suited me and what I wanted out of it. There’s not much conversation on many of these networks, so I use my imaginary friends instead. Because my Twitter account is so bad in number-crunching, status-seeking terms, I’m generally blocked or otherwise ignored, certainly not taken seriously most of the time, if at all.
Better, then, to have an imaginary audience, one which performs for you. My imaginary audience isn’t too petty (but just enough) and has a highly-developed bullshit detector. It’s knowledgeable in a variety of relevant topics and sees things, not in a temporary fashion, but as part of an ongoing process, leading somewhere. It sees social media, in the short and the long-term, as a tool for personal and social change. My imaginary audience, obviously, is me during my better moments.
I’m not entirely sure why, but I tend to throw out a lot of highly personal stuff – stuff which my follower-count suggests I shouldn’t in the manner in which I do. But that’s not enough to stop me from doing it. It’s become almost a compulsion, partly because the rewards have been so worthwhile over time. I don’t throw around everything – there’s a few things even I wouldn’t – but enough to be a cause of embarrassment, if I saw it all that way (I don’t, though I’ve got to take into account other people can).
It’s a bad strategy for social media use as we’ve come to think of strategy. So bad, I’m probably the only person who’ll ever use social media in such a way to talk to himself. That might end, now, as I’ve reached some sort of conclusion with a particular approach to life. If it does, I’ll miss it a bit, though I’m sure other approaches will take its place, as they tend to. It seems to have served its purpose, now, and if it’s time to move on, then it’s time.
Does the same apply to other things? YouTube, for example? I don’t know. I’m once more starting to make videos I actually like, videos which are getting closer to my voice, rather than one too heavily reliant on existing media influences. That comes across in how I’m talking to camera, too, as the power of the lens and the world behind it have balanced, with me coming more to the fore from beneath the avalanche of memories which has buried too much in the back of my mind for too long.
I can still vividly remember the day, about 20 years ago – the where, the when, the who – when I told a friend I was getting too cynical, pretending I didn’t know why, but understanding all too well that things were going drastically wrong. Even without, at that time, a thorough understanding of my local culture, I somehow knew they would in ways which told me that in small, cut-off communities, crazes around archaic subjects like witchcraft and wizardry may have changed their overt subject matter, but the characterisations, bizarre beliefs and motivations retain their ability to consume even while their victims are convinced of their sanity and modernity. The craziest of times would last a long time, fuelled by the type of characters you can possibly imagine.
You don’t want to hear it. You really don’t. Even if you did, you wouldn’t believe a lot of it and no-one would admit enough to verify what I can say about it all. But I no longer need to verify or even tell it. It’s done. The craziest of times were over a long time ago and in not processing it all properly, they lingered in my memory, retaining a sort of relevance. But in taking the longer route, I now understand it all even more, and in exposing their true meaning, they’ve lost their power to haunt. They’re very dead ghosts.
There. There’s a bit of writing. I’ll post this. A few people might read it and I’m even dumb enough to check the stats. Double-figures mean party time, let’s put it that way. It’ll probably read bizarrely, but my imaginary audience will work away on it and all the rest of everything else to seal in place this peculiar, but successful method of progress, which is opening up the world again on more peaceful terms. For the first time in about 20 years, I can feel the soil beneath my feet and, if only you knew, you’d know that that’s some achievement.
Rough guess: between 2-5% of people writing about madness in the media and online know what they’re talking about. I don’t include myself in that figure, because I’m still developing my thinking and have quite a bit more to learn about the field, but I’m fast getting there. The thing is, if it’s only 2%, how come?
What with the fact that psychiatry is heavily about engineering conformity to norms along with what I wrote last time about the copycat element of ‘self-harming’ not to mention the placebo effect involved in anti-depressants’ successes, I can’t help but link in the success of orthodox psychiatry’s powerful position with studies pointing to poorly considered conformity to authority and status.
Indeed, the success of neo-Kraepelin psychiatry’s smoke and mirrors can be equated with the way the toothpaste brands used to sell us their products on TV, with an actor dressed in a lab suit using pseudo-scientific phrases about whiter than white. What with bio-reductionist psychiatry flying in the face of science, along with the disempowered helplessness of people persuaded by the constructed pathologizing of much ‘normal’ behaviour, not to mention more transgressive thoughts and acts, I have to wonder whether psychiatry’s success in pulling the wool over most people’s eyes is down to little more than disempowerment by misinformation and conformity to what’s seen as a higher order.
It’s easy to stereotype dissenters when you’re living within the confines of traditional psychiatry. They must be scientologists, they’re in denial, they’re dinosaurs compared with our modernity, and so on. But, because I’ve been on both sides, now, it should be easier to see the terrain of this debate in better ways. Going on my own experiences (and having transformed them), then, I’ve often rebelled against the system only to find myself, once medicated, at the disempowering extreme of complete conformity to the norms and values of the system and my locale – both fairly reactionary and conservative – which I’m not ordinarily instep with philosophically.
In your conformity, though, you also face abandoning any argument that risks true analysis and clarity of the true state of affairs by putting such questioning and doubt down to illness in the face of what can be the overwhelming opinion of those around you, especially on mental health wards, not to mention online, in the media and, well, in society in general. You fail to even begin to realise that there are many ways of perceiving and acting around popular conceptions of causal factors and mental states, pathologized and decontextualised or otherwise. Sometimes, in desperation and the absence of any understanding of the possibility of better alternatives, you may want to believe in something – anything – and traditional psychiatry increasingly fits the bill, backed by limited perceptions and blatant falsehoods almost everywhere you look.
You maintain what many in the system have long experience of – inadequate reasoning, poor problem-solving skills and other common features of problematic relationships – to reject good arguments and laud the bad, especially when these come in the form of the sales techniques of toothpaste manufacturers. You sacrifice empowerment over even information by surrendering your mind and senses to the wit of people who don’t tell you the truth about iatrogenic effects, causal factors, how psychiatry really conducts itself across the board from research to treatment, diagnostic irregularities, and so on, but instead give an air of authority and prestige in making many declarations about things of which there’s no certainty on the one hand and make-believe on the other.
This isn’t to say that people who advocate neo-Kraepelin psychiatry are bad people. I’ve yet to meet anyone in the system who, at some stage, I didn’t think went into the service of people to help them. But the fact that their work is based on a belief system that flies in the face of reliable science means that what you’ll often find – in the rare moments when there is the chance of effective debate – is the very type of reasoning errors and bogus stunts that can look so reasonable to those who often know little better because of their past exposure to similar ways of arguing: for example, shooting the messenger, giving incomplete evidence, not engaging with arguments when you don’t have the evidence so you don’t have to admit it, ‘Crucible’ logic and the prestige suggestion so heavily involved in also selling toothpaste.
That, by my very rough estimate, merely 2% of people in the media and online actually know what they’re talking about when they discuss madness, could say many things to many people. To me it isn’t a sign of an open and shut case according to popular opinion (though I could easily become derogatory in arguing that). Instead, it says that there’s a societal problem around norms, prestige and empowerment (not to mention professional, financial and political interests) which needs an overhaul in radical and creative ways.
Earlier today, I read a tweet by a prominent psychiatrist apparently debunking a theory about madness. He was wrong in fact and dubious in his casual populism. The temptation was to engage him. I didn’t bother, partly because of the reasons outlined in this post, but also partly because, despite everything, I didn’t want to just in case I was had, as I also buy toothpaste based on the dubious claims of actors in lab suits.
Last year I was a paranoid schizophrenic. This year I’m bipolar. Next year I may be eating cheese on the moon. However, as is common in traditional, bioreductionist psychiatry, this doesn’t flag up concerns about flawed terminology or diagnostic processes. Instead it’s seen as a simple shift in diagnosis.
Me and my psychiatric team get along very well. Unlike many of these therapeutic relationships, it avoids the more creepy elements of a parent-child dynamic that the system can so easily engineer through a combination of dysfunctional former interactions and other disempowering processes. It wasn’t always this way, but now it’s a healthy, more open one, partly because I’ve worked hard to ensure that’s the case. That we disagree so fundamentally about just about everything to do with psychiatry is a testimony to what a creative approach to persistence, compromise and workarounds can achieve.
We disagree, but we might as well not, because the results are essentially the same. I’m on medication for life. To them it’s because of an underlying disability. To me, it’s because I was put on medication that I didn’t originally need, but which my brain cannot now manage without, a medication that’s even known to cause significant brain damage.
The origins of this state of affairs, to me, were social and psychological, though they sound biological, too. Epigenetics essentially worked against me, as did a lack of specific psychological skills in a social environment that was not only made up of intense stress, but also designed to build on it (the ‘tl:dr’, ‘shit happens’ scenario). Although that sounds like a biopsychosocial model, it’s primarily about nurture, not least the epigenetic part.
Psychiatry’s essentially about conforming to norms, though ironically, with treatment which doesn’t tend to like context, preferring to isolate issues as within the body and mind of the individual. But what specifically are these issues? Well, they’re whatever psychiatry says they are, regardless of what the science actually says. Therefore, if you enter any gathering of people who work in or use mental health services, you’re likely to hear myths spread as if they were part of miraculous religious conversions, like chemical imbalances of the brain, neurological disorders and genetic flaws, even though such beliefs are inaccurate and damaging.
Originally a believer in sociology and the idea of context (sociology and psychiatry don’t get along) this was blasted out of me in my first encounters with the local mental health hospital. This, along with medication and persuasion centred all the problems I encountered as internal, thus denying context and any chance of real-world solutions based on a full picture. The results were catastrophic – I conformed to the psychiatric norms and those of my intensely conservative social environment, which led to prolonged and severe mental illness with numerous symptoms, most of which I’d not had before. As I’ve written elsewhere, I eventually reversed the tide by reintroducing a grounding context and returning more to a coherent, stable character. But it took a chunk out of my life I could have made better use of.
However, there lies one of the problems. I conformed to a set of scripts about diagnoses, symptoms, and so on, that you can see repeated by far too many people who don’t question what is going on and why. We know that the phenomenon of ‘self-harming’ is – and I wish there was a more diplomatic way of putting this – little more than copycat behaviour. That’s historical fact, so we have a whole load of people conforming to a damaging behaviour because they’ve essentially been told that this is how people at the extremes of the system alleviate internal pain. We know the positive effects of anti-depressants tend to be down to the placebo effect, so what does that say about our current thinking around, and conformity to, ideas of ‘depression’, not least the more meaty terms from the DSM, psychiatry’s bible, which I’ve read being called ‘The Book of Insults’ and with good reason?
It’s well known in some circles, though not popular knowledge, that psychiatry is not only based on bad science and thinking, but also that society as well as the system is in need of reform. At the moment, we’ve got a bad system propping up a dysfunctional society. We need reform, too, in the skills we need to navigate life, but that doesn’t mean we’re somehow inherently flawed and that reform doesn’t matter. However, most people are sidetracked into arguments, debates and initiatives that maintain the status quo and are, if anything, detrimental to public health, all things considered. And, when the blurb to initiatives suggests a radical approach, it’s usually a sign to look closer at the wording.
No-one in the system, until very recently – though, funnily enough my relationship with most workers in the system is excellent – ever told me about the importance of key contextual factors – race, class, culture, economics, political influences, etc. They frequently gave me worldly anecdotal advice on how to live life according to their personal norms but always within the framework of traditional psychiatric thinking, on subjects they were often unqualified to comment on professionally and with a worldview that taught me nothing of how to negotiate a healthy relationship with, and understanding of, my environment.
Since November, I’ve been looking more into mental health. It’s thrown up some fascinating theoretical standpoints and interesting initiatives – many of which even call into question the functioning of traditional psychiatry – but still nothing that practically goes far enough. What this research has done, if anything, is highlight that there are very few certainties around the subject of madness, aside from the knowledge that most things are uncertain. Clinical psychiatry may deal with false certainties because of understandable constraints and limitations, but this shouldn’t be good enough to protect it against the reforms it urgently needs, even while – because of its powerful position in society – it doesn’t need to enact anything.
Meanwhile, most people are left in a form of limbo they have little idea about, living according to a set of narratives that they fail to fully grasp. Are we really allowing such a flawed system to influence how we think and feel and react so much and with so little supporting evidence? Seems so. The good thing for me, at least, is that in having looked at anti, critical and pro-psychiatry material, I’ve reached a point where I’m personally comfortable with the service I receive, I understand my options, and I’m not wrapped up with concerns over stigma, discrimination or ideas about symptoms because I know that to be so concerned about things no-one really knows much about would be foolish and because the service is ultimately based on nothing more than rough and deeply flawed guesswork.
The main frustration, though, comes from knowing there’s other people who could benefit from appreciating such uncertainty, acting accordingly and helping to drive reforms that could comprehensively work, rather than, sadly, being little more than their master’s voice in so very many ways.
On Monday, I went to psychiatric services to see my psychiatrist and break the news to him that I’d come off a neuroleptic, gradually, over nearly a year, and that I intended to withdraw from a ‘mood-stabilizer’ similarly. It was obvious that the hospital had got wind of something when I got there but, instead of relating this to me and expressing any concerns they may have had so we could discuss them, the type of odd and counter-productive behaviour I have had to put up with over a 14 year involvement with psychiatric services continued, with the patient disempowered in a process keeping them outside of knowledge. That failed approach has already been planned for way in advance of recent times. I know that. Psychiatric services know that. But they will use that to act against me, too. The world could and should be a far simpler place. And all this for what? Whatever issues services have, they should have very little, if anything, to do with me. That they probably can’t see that speaks volumes for their approach down the years.
In a letter I’ll include at the end of this post, I spell out a few things that may lead to a move from the medical model, which faces impressive and widespread calls for significant reform even within psychiatry, to a social approach to mental well-being. However, in the letter, I call for psychiatric services to not escalate matters, as they have a pattern of having done for years, but have an open mind and give an alternative approach a good chance of success. It already seems like that will not be allowed to happen, for whatever side issues there are, which I’m barred from even discussing, and which few people who aren’t aware of the stunts that get played would believe. They are basically designed to engineer mental distress to a degree which is meant to necessitate a medical approach, with no room for alternatives ultimately allowed.
I will say one thing, which seems to go beyond the realms of credibility, though that’s the way it’s supposed to be seen: during my last spell in hospital, the Consultant Psychiatrist there blatantly lied to a tribunal which is supposed to act as a safeguard for me. That’s illegal. Or it would be if the tribunal was little more than a show trial, a mock-up, the outcome of which had clearly been decided in advance, which is why I refused to attend another ‘safeguard’, which was a hospital managers meeting at Worcester Royal Hospital. Tip of the iceberg, a lot happens when psychiatry gets carried away, as any institution which can impose meaning, power and a preordained agenda, without safeguards or access to human rights, unless those rights square with psychiatry and fall within a psychiatric framework, based on the dominant medical model. You don’t believe me? You’re not meant to. That’s the beauty of it.
There’s not a lot I can do. Despite the fact that I know that medication is a detrimental long-term strategy, and my well-being does not require it, if precedent is anything to go by, my environment will become so difficult to deal with that I will be forced onto the medical model, which will then – yet again – be used as ‘evidence’ for the long-term ‘need’ for a medical approach. As my last admission to hospital demonstrated, it is almost certain that there is not a lot services will not do to try to accomplish this, with the prospect of engineering an embittered, disempowered individual who knows that he lacks fundamental freedoms which everyone should be entitled to. Sounds bizarre – entirely unbelievable – but I have enough to go on to rationally conclude that. And it’s almost certain that there is nothing anyone else can do about it, either.
Letter to my Consultant Psychiatrist
9 September 2014
Dear Dr S,
Firstly, thank you for your flexibility during my appointment with you yesterday. I had been, in retrospect, overly concerned about how you might react to what I had to say, but I was reassured that you took such a considered approach to the encounter.
You raised the issue of whether, if my health deteriorates to an extent you believe necessitates anti-psychotics, I would take Quetiapine. I tried to be non-committal, not only because I don’t think anti-psychotics are the long-term answer and want to find a better, workable solution to the cycle of long-term medicine followed by withdrawal, but also because of wanting to deal with any issues as they arise, if they do. I have to admit too, though, that my initial reaction was to be opposed to any anti-psychotics at all.
However, though there have been many things I have been doing since my last admission to hospital to address my psychological and social approach to things, which I think bodes well, especially if built upon, there are naturally going to be concerns based on precedent, not least the severity my condition has reached at times. So, after considering this, it is clear that you need to prepare for the worst as one of the potential outcomes of my proposed gradual withdrawal from medication and hopes to shift to a more social approach to my care. Therefore, it is only fair to be cooperative on this and try to find a solution with you. From what I understand, anti-psychotics can be beneficial in the short-term to avert the worst of a psychotic episode or to recover from one, though there is also evidence of the benefits of this being only short-term for people with my diagnosis. Therefore, if you are open to it, I would welcome discussing with you the available medications and strategy so you can implement a plan in the event that things turn for the worst and what the full options are beyond that. I am more than happy to include the use of an anti-psychotic in that, while wanting to keep our options open as to which one would be the most appropriate in light of the above. Your concern may be that this could impede the benefits of a long-term medicinal approach, but even if that was the case, working towards this proposal is more flexible by adjusting around precedent, providing necessary safeguards and keeping our options open.
I also want to give you some additional feedback about the appointment, which I offer in the hope that you will find it useful. As I have mentioned, your flexibility was very encouraging, but your concerns were, too, as they demonstrated that you will keep a close eye on things and try to prepare for any negative eventualities. A disappointment was that you seemed to be completely uninterested in social approaches to mental health, as these are the approaches I have always ultimately considered more viable for me, all things considered, and have some interesting advocates within the psychiatric profession as well as outside of it. Although I would not wish to offend you by trying to tell you how to conduct yourself professionally, I have to hope that, as my clinician, you would be more open to such approaches, increasing the options in your clinical toolkit and, therefore, those readily accessible to me. In appearing to be so uninterested, that may lead to a situation where, while your aim is clearly to act in the interests of my health, you could unwittingly reduce the chances of their success in favouring the medical model of psychiatry to the exclusion of all other options, while a social approach is also in the interests of my health and may eventually prove to be more beneficial. You might never know if you are reluctant to explore the option, which would be a pity, not only for me personally but, I think, for you professionally.
Another concern was your unwillingness to prescribe tranquilizers. I understand that they can be addictive, but I think on the basis of my general approach to medicine, you can trust that, on PRN, I would not abuse them or remotely risk addiction. Moreover, my experience has been that psychosis emerges after a prolonged period of intense stress, which builds up over time, often initially from quite insignificant moments. That can be external stresses or internal ones. Regarding external stresses, my home life is better now than it has been since even my first involvement with psychiatric services. This is down to basic common sense as well as social approaches I have learned and applied, though I am at the very early stages of looking in to these approaches. For example, my mother and I have openly and rationally discussed our stressors and overall relationship and why we think it has deteriorated at times, implementing numerous improvements. That has led to a greater understanding between us and an everyday life that is healthy and enjoyable. My extended social life could be improved, but that is also without stresses, as I do what a lot of people do these days and make use of technology to keep in contact with numerous people, many of whom act as a support network when needed. Overall, my home and wider social life are as good as I can expect and hope them to be. I’m content with both.
Internal stressors are another matter. Again, though, because I find that psychosis tends to emerge from prolonged, intense stress, via a poor response to environmental events that go unresolved, I believe a tranquilizer could be effective at times. Of course, it would not be as effective as an anti-psychotic if psychotic thinking were to emerge, especially if this was an exclusively internal process, but as I have mentioned, I am sure you will now be able to plan for that. However, a tranquilizer may be a viable option to offset at a very early stage relatively minor stress so it does not lead to something significantly more problematic. As my body adjusts to changes in its chemical composition, there are naturally going to be times that are stressful, but which are not necessarily psychotic in nature. For example, if there is an increase in dopamine receptors following withdrawal from a medication, if that withdrawal is handled in a measured way, the changes and response should be less dramatic, though still delicate, because of potential changes in thinking. Though I think both positions can be argued quite easily – that you could use anti-psychotics or tranquilizers for this – the information I am going on suggests it is just as valid to say that tranquilizers can help with this process, allowing for moments of calmness and reflection which can assist and even extend the integrity of the personality at crucial times. This should, in theory, allow the body and mind to make its adjustments gradually and adaptably, without unnecessary extremes.
Because I also spend a lot of times indoors, I sometimes get mild cabin fever, which I’m accustomed to managing and which doesn’t last long, but during this time of withdrawal, a tranquilizer may occasionally be beneficial. Unfortunately, we did not develop this discussion, so I could not clarify my stance and get your specific feedback on issues around tranquilizers. I think a concern for us both is that a deterioration in terms of my mental state – whether triggered externally or internally – could quite easily have a knock-on effect at home. Personally, I cannot see that, now, though I also cannot rule it out, so, although it may turn out to be unnecessary, had we developed some strategy around this yesterday, I would have been a lot happier and I hope it would have assured you in some ways, too.
A socially-based approach could make a significant difference in outcomes, rather than what I am concerned may happen, with existing support avenues doing little more than wait for a time to medicate, having prematurely dismissed the support I am requesting, without even trying. Despite undergoing Relate counselling that has proved very helpful in the long-term, however, similar approaches have never been followed up by any of the psychiatric services I have been involved with, which I think has been a great pity.
This may be down to some of the ideas in services towards me. During my last hospital admission, a senior nurse said that I am ‘a danger to men, women and children,’ when he became frustrated that he could not give valid reasons as to why it seemed I was being denied my rights. The Consultant at the hospital, also had a sense of urgency in stating that ‘there is something in you’. Both, of course, are unscientific, but have to have come from somewhere, but not from any potential or internal bug I possess. Now, not only is this a long time ago for me to have accepted that it is not really relevant to my everyday living, but I am old enough to know the difference between form and content, appreciating that what people say does not always equate to what they mean, but these are strange things to say, regardless of whether they were believed, especially in their extremity. That services may actually hold such views and concerns like them has never been addressed and, although they should realistically have nothing to do with me, may be a reason why there is a problematic and detrimental reaction to what I am suggesting. The additional, wider concern should also be that if such claims, which often lack the processes to be openly discussed and resolved, are being made on a frequent basis to vulnerable and suggestible people, such people face the danger of internalising them or taking them to heart, whereby they could raise not only their risk level but also complications for their mental state.
So, although we are on our way to implementing safeguards in case my mental state deteriorates, I think it is also wise to consider how the relationship between me and psychiatric services has often been one of escalating rather than de-escalating matters, especially during medication withdrawals, with services sometimes seeming to see this as appropriate in terms of care to get me back on medication, when far simpler strategies could be more effective if that possibility were seriously entertained. Because the dynamics of the typical relationship between a psychiatrist and their patient differs substantially to that between talking therapist and a client, it may be helpful if we think about why my approach to psychiatry is sometimes seen as problematic. The latter relationship is more appropriate to me because it’s less a process of judgement within a hierarchy, more a discussion, leading to rational solutions, fully taking into account the views, perspective and intentions of the client in a more modern, egalitarian and empowering environment. So, maybe instead of this being seen as a problem between me and psychiatry, it would be more productive to consider and work around what I have thought all along and even requested at the start of my involvement with services: that the design and methods of the talking and social approaches have always been more appropriate for me and my well-being, as they fit in with my personal history and philosophy. If that conflicts with the view of services, then I suggest we have lacked something significant somewhere along the line. So, although I know you find it difficult to relate to how I approach you because of your perspective, I hope you can appreciate that it can be the same for me from mine, but also that it’s not a measure of disrespect by any standards or a battle of wills, but more a question of the inappropriateness of the model we have consistently worked on, with little substantial success, for all concerned.
While I am also looking into the methods and approaches I have proposed a greater emphasis on, though, it is not ideal for a lay person to try this alone – it being always beneficial, instead, to have professional, experienced and informed support to assist you in your development. It should be a simple matter of choice, though I acknowledge there are complications that need working on which are as much to do with me as services. So, despite agreeing with you that psychotherapy, for example, should wait until after I have recovered from medication withdrawal (fingers crossed), that should not necessarily mean there is no counselling or similar support available at all as I go through that process, to help with it. That could be with you, though my reservation with that is, again, that this is not your speciality and you may have some sort of funnel approach, seeing all options as inevitably necessitating medication in the long-run and working towards that conclusion, which would be unnecessarily detrimental to the alternative I hope for. Ideally, as I tend to benefit from considering different people’s informed opinions on important matters, it may be wise to consult my G.P. and someone who specialises in socially-based therapies, as, especially with the latter, their perspectives may differ to yours in relation to a specific non-medicinal path. Although this conflicts with some of your advice, it does not conflict with your ultimate goal of securing my health, so I hope it is an option you are not too uncomfortable with. Moreover, talking therapies, at least, are supposed to be more readily available to patients, these days, and are also offered to those both taking medication and with diagnoses like that with which I am diagnosed.
The advice I have come across on withdrawal makes clear that withdrawal from medication can all be quite a rocky road and there are times when it looks like symptoms are re-emerging, while this can be more a symptom of adapting to chemical changes within the body which tend to decrease in time, if the process is properly managed. Even though I acknowledge that both can also be the case simultaneously, I am hopeful that you will be able to distinguish this and act accordingly, should such issues arise. You did mention that it can take months for deterioration after medication withdrawal, but this was a very important piece of information both for a medical as well as a social-based perspective and it was something I will have to keep paramount in my mind in the coming months, at least. However, I have to repeat that I would be even more hopeful of all this if you were more receptive to these social approaches to mental health within psychiatry than you appear to be, as that could be an option to build productively on your flexibility, and does not necessarily remove the option of the medical approach once and for all, but does not instinctively rule that out, either.
You were very personable, as usual, which is always nice to experience, but you also seemed uncomfortable about what I am doing in terms of going against much of your advice (even though you are allowing me the opportunity to try a different approach). Your seeming discomfort is entirely rational, but as I think you already knew we would reach this stage – I hope you do not take offense about the withdrawal, as you seemed to know that was going to happen far sooner than I did – and that the disagreement is of concern to us both, I would have been more satisfied had the appointment progressed further so we could have discussed matters and options more. In other words, you did seem a bit eager to cut the appointment off short, where further discussion may have led to observations, options and strategic points which may have been of benefit in the long-run, not least in alerting me to potential physical reactions, behaviours and thought patterns I may need to be mindful of. Furthermore, despite disagreeing, we seemed to be getting along well, which also bodes well, whether things go well or take a turn for the worse.
As I tried to clarify, I am receptive to what you have to say – I may disagree with you about some things, which can understandably affect your professional pride and I apologise if that is the case. I do listen carefully to you than I think you realise, always taking away with me what often prove to be valuable points to consider and reflect upon. That is a common way I approach problem-solving (when not in a crisis) – not making rash decisions on the spur of the moment, but taking time to think things through when that is appropriate, aiming for the best solution in the circumstances – so I hope you consider this in future and realise that, although I may say things that sometimes sound dismissive, disrespectful or uncooperative, it might help to know that with me such things are not always as they may initially seem. Again, I think that I just find the psychiatric consultation process to sometimes be insufficient for my needs, though that is not an issue specific to you.
I understand that all of the above may still be unduly dismissed and I think I can see it from your point of view. Though I doubt you will do this, it is as easy to caricature someone with such ideas as it is to caricature psychiatrists and psychiatric patients, something which in the cold light of day is best avoided. However, with ideas like biological determinism and reductionism, insight, psychosis, relapse and so on, it is always going to be difficult to de-escalate concerns and simplify the rationale for a different approach, with services more inclined to default to a set standard, regardless of its ultimate appropriateness for me. I hope we take into account the butterfly effect, try to work in the interests of my well-being with an open mind and, regardless of whether or not I get it right this time, acknowledge that we will have a plan in place that should go some way to addressing potential concerns now and in the future, while also giving another approach a good chance of success. Apologies for writing such a long letter. It would be silly to try to cover everything I could, but I thought it only fair to give you a sufficient account of my thinking for you to be able work with.
Today, I have an appointment with Dr K, who I will give a copy of this letter to in case you wish to confer (which I would personally welcome), and I will request that he writes to you about the weight and heart issues around Olanzapine, along with the status of my physical health after my latest blood test.
Again, thank you for your flexibility, I hope you accept my feedback in the way it is intended while I am also open to discussing it with you if you wish to do that, and I look forward to my next appointment with you, but I hope that is without what turned out to be the unnecessary apprehension I felt yesterday.
There once was a priest of a large congregation you’d been led to believed in, but you went away after learning there was more to life. You thought a bit, learned some more, and came back, seeing him, his congregation and his gospel in an entirely different light. The priest had a background no-one could really question, but which you weren’t entirely comfortable with. At one time, he’d developed his faith with the Nazis and, though he swore that this had nothing to do with his political outlook, activity or what he preached now – admonishing you for even bringing it up to make you look bad for mentioning it and him look good despite doing it (raising the question of whether this was the greatest confidence trickster of all time) – you retained your doubts, querying if this could be more significant than the priest wanted you to think in light of seeing how he related to people, how the congregation worked interpersonally, how the gospel and its ways were spread and who were the main beneficiaries of it all. However, you had to tread carefully: the priest had a bizarre attraction to personal power, even at the expense of his congregation, to the point that they were dependent on his every word, while outsiders had merely to submit to them with the excessive respect and abandonment naturally deserving of someone of such high prestige as the priest.
You’d also discovered a worrying attachment the priest had to worldly goods, with him doing many things to bring in the bucks. He sold Coca-Cola laced with toxins as medicine to people who wanted to believe so much that they’d often sit around singing it was ‘The Real Thing’, thinking the tonic had cured them and they’d rejoice, telling others about this magical concoction and their new found freedom from anything other than The Real Thing. Then, when the funds from them wasn’t enough, he’d start selling it to more people, convincing them that they needed it, too. And didn’t they come in numbers, having got word of the wonders of this priest, who would advise them on how, when and why to drink Coke. And they believed, partly because they saw what happened to those who didn’t drink it. And it made sense and they believed. And when they didn’t believe, the toxins the Coke was laced with would space them out so much that they’d then either believed the priest when he said anything, not least that it was working, or they had to put up with having it forced down their necks, because they were too far gone, there was no-one to stop it and no way to get out of the congregation. If they couldn’t be restored by the wonders of laced Coke, then it was best to just give it them, keep them out of view (they weren’t good for sales) and hope for the best.
But, although there was no-one to really query the ways of the priest, there were Others. Others who called the congregation nasty names and made them feel bad and mad. Ignorant fucking bastards – no education or class, the dirty fucking scum – MOM, DAD, LOVE, HATE – why are they so nasty, Dad? The priest was in a bit of a fix, here, as his own work had led to this as his entire gospel was built on ideas of bad, mad and everyone else. But he managed to convince the believers that the Others didn’t know what they were on about. There was nothing wrong in drinking toxically-laced Coke. It was all good. He hatched a plan to get the congregation to set up communities to spread the gospel that all bad names were bad (unless they were the priest’s bad names – the Church has its needs, after all). No-one really thought to wonder exactly why the names were bad in the first place, but they believed, and so went about doing whatever they could to tell even more people that they needed to be nice, learn happy, nice names and believe, because bad names are bad, we must all believe and we must like the congregation, because their future depends on it, without even realising that, like that Coke, they were the same old names merely dressed up in the priest’s gowns, and the fact that they’d still make the congregation look the same as the old bad names would just feed through to the Others, anyway. The priest clearly had to do something, so he just got more and more people drinking Coke and saying the same things again and again, but making it that they wouldn’t think about anything they were really saying – they’d just be spaced out on the Coke and the gospel, capable of only listening to his words and his words alone, whoever said them. And it worked. Well, for the believers, because they were believers. So, they came to believe that if everyone was nice and if they supped their Coke, the world would be a nice place for believers to live in – The Real Thing – because everyone else, including the Others, would believe, too, whether or not they all drank the Coke, which they probably would in the end anyway. Let’s face it, if it ever came to that, would they have a choice? Well, if the history of the priest’s church is anything to go by, if the world doesn’t want The Real Thing today, you can bet there’s someone, somewhere, working hard to make damn sure it wants it tomorrow.
Having reformed from being a believer to seeing all this in a new light, you realised that there was no such thing as the curative properties of toxically-laced Coca-Cola and that the believers had lost it, not seeing the priest, his names and his Coke for what they really were. But something had happened where it was nearly impossible to save the congregation. The priest had managed to spread his gospel – or, more accurately, have his gospel spread – by newly-appointed priests, along with the congregation, to such an extent and with such a bizarre form of logic running so deep that any contradiction of the gospel brought with it accusations of heresy and the perception of the heretics as possessing the very maladies which afflicted the congregation and even its priest. So, evidence could be neutralised and you were just believing against a better belief, with the deciding factor being who could obtain the most influence and power to persuade the most people. Coke all round! Everyone’s invited! Homogeneity embraced, worldwide…so long as you sing from our hymn sheet. Welcome to Planet Asylum, the studied concentration camp of conservatively-nice, American-Dream-happy homogeneous understanding, aided and abetted by the philosophy and consumption of toxically-laced Coke! No safeguards or escape necessary.
There was little you could do, as too few knew what was going on and fewer were speaking out in a climate where everyone already believed in the gospel and naturally disbelieved the heretics. You watched as even the left-wingers in politics, usually astute in seeing the political dimension of things even depoliticized, developed a blind spot to end all blind spots where the gospel was concerned. To them, also, toxically-laced Coke and the gospel became the way and the light and the truth, while the Others had to be baptised in the new religion or we’d never be saved. The Others – who were only really taking their lead from the priest – had to stop treading on the congregation, according to the left and other believers in the gospel – while failing to recognise that the priest really wanted this pleasure all to himself, something that, once more, would get the Others following suit. But who needs friends when you’re your own best enemy: the congregation, duped as they’d become to chase the rainbow of more bad names and laced Coke, couldn’t even see that it was also doing a good enough job of doing the treading to themselves. Top up, anyone? The left’s instincts against imperialism? Nowhere to be seen, because they’d lost the ability to see it that way, as the priest pushed his gospel around the world to places where the original thinking and (more effective) solutions were overridden, the booty conveniently ending up in the lap of the gods, as the congregation expanded yet further, even ending up in trying to silence political dissidents. Deviants! Heretics! Meanwhile, the seats of learning, with their congregations in place in the universities, would sacrifice everything the PR says they cherish to the feet of the priest, but making sure to take backhanders for spreading the gospel, making it more likely that those outside, who would usually say something based on the evidence available, were not only clueless but less likely to even discover they were clueless in the first place, the morass of bad learning had become so deep.
In the face of all this, you could additionally see how the Coke often made people ill in ways they frequently couldn’t see, dragging everyone down as the ever-increasing moves to sell Coke could drive nearly everyone nuts with increasingly more people losing the ability and the sense to resolve what had previously been even minor issues. You witnessed the priest’s ways in all fields of life extending yet further, like it does across the globe, only more inwards, too, creating the need for ever more Coke and working against anything that would get in the way of people supping it or the way of life that sustained its perceived value. In the end, then, you just thought ‘fuck this, I wanna get off.’ So you did. You, at least, knew, and so you let the congregation be on their way, clutching The Real Thing as close to their hearts as they could, with you glad that you’d been there, mainly because it meant that you never wanted to go there again. What about the priest? Despite everything, it could just be down to a matter of time before he’s got the whole world in his hands.
It’s been about two years, now, since I was hauled into the top tier of psychiatric ‘care’ in my county after being assaulted at home and my assailant misleading the police about it. On the basis of further misleading comments from my family, I’d eventually be placed on medication I’d said in advance had always done me harm. Over the course of the past year, I’ve been withdrawing from one of those meds, Olanzapine (an ‘anti-psychotic’ and ‘mood stabilizer’), after being told by my GP that the effects of it had led to high cholesterol which put me at risk of a heart attack. In my last meeting with my psychiatrist – someone who I don’t mind, personally, but whose profession I don’t believe in – he stated that my GP has said no such thing, leaving the door open to being forced on the medication again.
Last year, I tried to come off all meds. Not only on psychiatry’s standards was my admission to hospital and the imposition of medication botched, but by any rational standard, the whole situation was dealt with badly and even corruptly, with poor assessment of the evidence and illogical conclusions being made of it. But my mistake last year was in merely acting on the basis of this and not tapping into my long experience of mental health and medication to acknowledge that, once psychiatric medication is in your system, it’s very difficult to come off it. I was rendered incapable that summer, spending much of it deep in psychosis as my body and mind couldn’t adjust to the withdrawal in the time I’d taken to come off the pills.
This time, often working closely with my psychiatrist, I’ve taken a year to come off just the one medication I’ve been on (I’m also on a ‘mood stabilizer’). I’ve had a year of tapering off a chemical that I’m now free of, but even so I’m still enduring an exhausting process with a lack of psychological stability along with the physical punishment of quite severe sleep deprivation as my body gradually adjusts to the new reality and my brain slowly restructures along with my mind. It’s certainly not easy, especially the frequent absence of self-reflection, but it’s something that’s almost impossible to get support in doing (though there are resources online, should you wish to chase them up), not least because we live with a culture which, while having no reliable evidence of the claimed benefits of psychiatric medication beyond limited and disputed definitions of success, asserts almost universally that you should take ‘your’ meds, even seeing the body’s natural adjustment to coming off them as a reason to be on them. It’s just the way we’ve been conditioned to think and that conditioning’s just about everywhere you look.
If I’ve made any mistakes, this time, it’s been in not tapering out the withdrawal long enough, not giving myself time to become stable for a duration before embarking on the next reduction, but even here, there’s not a lot that would have prevented the situation I’m currently in, of being incredibly weak and tired – it’s just part of the process I’ve got to go through and, despite the instability, it’s nothing major and doesn’t fall within the boundaries of ‘mentally ill’. Tired, irritable because of that at times, sure, but psychotic or having extreme moods? No.
What I do know, though, is that if I was on a mental health ward, I could be engineered into mental illness rapidly. That’s happened before in my ‘mad’ career, even when I’ve been functioning well, rested and what you’d call ‘healthy’ (to the uninitiated, these things do happen, and can happen more easily than they’d think). It wouldn’t take much to pull it off now, but what’s in my favour is that I haven’t currently got the social environment to make that likely, though that’s never far from being brought into effect. The last time, those two years ago, was the culmination of my half-family’s behind-closed-doors emotional difficulties and their manipulation of local services and the Police in a process that gradually enclosed me in their abuse of legal and medical powers, without adequate safeguards to get me out of it. Safeguards that should be in place were also abused and, in that environment, there was nothing I could do – no avenue of redress, even – but take ‘my’ meds and agree with the fanciful notions of a psychiatrist who had far more power than cognitive ability or ethical grounding. So, I complied and, in so doing, further empowered my half-family and the bogus structures that had built up around me. It was a blatant abuse of my rights, but one I’ve worked to come to terms with by rationalising around it. A tough process when your rights have been so badly trampled upon, but I’ve had no choice. There’s nothing I can do about it, anyway.
Like everyone I’ve come across in the mental health system, there’s fault lines in my family life. I’ve distanced myself from my half-family but, psychologically toxic and manipulative as they are, there’s always the danger that they’ll muscle in and I’ll be back on the merry-go-round of mental health again. My half-sister would be classed as quite severely ‘mentally ill’ by psychiatric standards, if psychiatrists went on the evidence of this. Highly manipulative with marked psychological issues, she maintains a control over my mom so that, in any dispute, my mom is likely to lie and sacrifice my rights to the system to protect her self-image. It’s an abusive and highly toxic situation where the family increases the level of abuse whenever it looks like the cat’s going to get out of the bag, and has been very successful in doing so. The problem’s compounded by the fact that local psychiatrists treat their comments as neutral observations, not as the misleading abuse they’re adept at. Indeed, my current psychiatrist, after my last meeting with him, has already claimed that I’m mistakenly ‘blaming my family again’. To him, there are no problems in the family, only with me, highlighting the dangers of poor critical ability in assessing situations (in my experience, common in clinical psychiatry) and making him vulnerable once more to being an extension of the abuse by my family, again in ways that I can do little about. My psychiatrist has claimed that he uses a ‘holistic approach’ but while they give the impression of comprehensive analysis, implying environmental understanding, they still instinctively reduce evidence to the individual’s perceived biological flaws. They really can’t help themselves, it’s so natural to them.
I don’t believe in clinical psychiatry at all. I’ve witnessed too much over the years. The fundamental basis of their medicine is a mess and the worrying thing is that so many people believe in it, without even bothering to adequately check. I’d started out, before being put on a ward, with a sociological approach to mental health. However, after the pills and persuasion that transform your mind, thinking and logic, I came to believe in all the myths and misnomers of the psychiatric profession, even blogging, as many do, about how much better I was with its help, how we needed to overcome stigma and educate the public. Yeah, that cliche. Now, though, I’ve regained my former approach and the proper conclusion: that the real stigma comes from psychiatry’s ideas about the aetiology of mental ‘illness’ and educating the public should mean informing it about facts, not the myths clung on to by the bulk of the mental health community. But that requires the people calling for the public’s education to become aware that they aren’t even remotely educated about mental health themselves, before patronising the public (and themselves) with their missionary zeal on a false journey of deluded hope that’ll only end with the very type of stigma they seek to address.
The situation’s not a good one. Even the left abandons its science and beliefs with the very mention of mental health. They might as well hoist a blue flag and sing ‘There is No Such Thing as Society’ as well as Thatcher ever could when the subject’s raised, they can hardly wait to abandon everything they hold dear in the face of the issue. Like the psychiatrists they take their lead from, they may pay lip-service to nurture and other environmental factors, but break down what they’re really saying and they’re peddling the same old stigmatizing notions of bad biology, without even bothering to independently examine what they’ve come to believe and how much of this approach has been discredited. In the modern world, I’ve got to wonder – outside of religion – if there’s any other set of beliefs so widely held with so little genuine examination and critical ability applied.
While I was spaced out for more than a decade, I did rise to the surface at times and argue such things as I’m arguing here and I also had the sense to pursue some valuable support. What I didn’t know at the time was that this would have a delayed effect, as the pills and ideas of psychiatry had to be gradually overcome. I went to Relate counselling, which meticulously looked at my social context, amongst other things – again, something psychiatry pays lip service to, but when it tries it, always tends to apply the same old framework of decontextualizing the individual to reduce issues to individual biology, to be resolved by other chemicals. Relate, though, almost immediately identified the fault lines in my family life and reintroduced me to thinking that I hadn’t had for a long time, developing some ideas into even more useful approaches. This would be the seed which would eventually give me the impetus to rediscover a sociological approach and reject most of what I’d been conditioned to accept within the psychiatric system.
Even now, though, as evidenced in my last post, it can take me some time to recall the sequence of events regarding, for example, the shifts in my approach and thinking. It wasn’t always that way, but after so long on chemicals, there was always bound to be consequences. I’m lucky, though. Even though I went further into psychosis than anyone I ever met in the system – stupidly, I’m even quite proud of that, but, again, this is not least a consequence of medication (as well as environmental factors that were compounded by the meds) – I haven’t remained on the brink of psychosis, as some people do.
But the experience of having been so far out does give me the authority, at least with myself, to reject the emotional stunts many people who’ve been in the system and live by it try to pull in defending bogus claims about mental health. I’ve been on forums in the past where the stunts are almost without limit in their extremity, but with most things psychological, I can match them point for point and the stunts fall flat. It’s a bit pathetic, like the scene in Jaws where characters compare injuries, but this is what discussions between people who’ve been through the ringer can be like. The pity is that a lot of the people who pull these stunts don’t even realise that their use of these stunts are often a big clue to where many of their problems really emanate from. I’m ultimately quite patient of that sort of thing, because I’ve pretty much been there and can understand why a lot of people cling to a system that can do them so much harm in ways they often can’t see, but that doesn’t mean that I have to agree with them, whatever bogus point they make, emotive or not.
But the body of opinion, however wrong, is, in terms of numbers, against me and other people who’ve discovered themselves the true state of psychiatry and mental health. But this is the way people have to do it. I could, as I’ve tried before, continue sounding off about it all, but it never comes to much. Until people make a concerted effort to challenge what they believe and investigate for themselves, talking about this stuff is like talking in a foreign language. People like me are also easily discredited and ignored. You’ve may have done that already in the paragraphs above, but to cover all the angles that are open to dispute and require significant reframing, it’d take a sizeable volume of writing. For myself to successfully come off meds, I’ve got to often think in creative ways, thinking patterns which are frowned upon in psychiatry, which likes things conservative, and broadly know what I’m doing, too. I don’t know everything and some of my thinking is more extreme than most people who think along the same lines, but at least I know, on the basis of a realistic comparison of approaches that I’m on the right lines.
These days, I can’t watch or hear or read a story on mental health in the media without seeing the cracks. What used to anger me was that most people can’t see them along with my urge for them to be able to. But why? If people don’t want to know and are happy taking their pills in blissful ignorance, while also thinking they’re on the ball as they try to ‘educate’ others into their borrowed ignorance, then they can go for it. That they’re not told of their options and what those options really are in the first place is wrong, but it’s common practice. To me, going to see a psychiatrist is little different to going to see a witch doctor or a clairvoyant. If you don’t believe me, check the science and check it properly.
The approach of clinical psychiatry is common practice that needs a complete rethink: a new approach to language with an entirely different perspective and reforms across the board in how we work as individuals and as a society. I’m lucky in that I had strong ideas about mental health before I entered the system, but the ideas and shifts in thinking required can be so great for many, along with the way psychiatry influences relationships and thinking, that most don’t ever even get close to realising there’s more valid options to what they’ve come to believe. Individuals need to be contextualised and the environment shouldn’t be depoliticized so the highly complex nature of nurture is recognised as crucial to everyone’s psychological well-being and reforms can be thought about accordingly. We need a system which, rather than doping people up to brush things under the carpet, addresses crucial issues in ways that offer long-term solutions, something psychiatry has never been able to honestly, ethically and safely offer.
For me, I’ve got to carry on trying to make sure I’m not put back on pills that could kill me, while taking the strain of the adjustments I’m having to make. All summer, I’ve been all over the place, but this should eventually level out. Then it’s time to think about the other med, then, in the years ahead, a transfer to psychological approaches, then discharge. I don’t tend to bother with debates on this, especially in the UK. The issues of prestige and deference that are such a problem in psychiatry are what beat the heart of Britain, so if I do talk about it, it makes sense for that to be done elsewhere. Even so, it usually doesn’t get very far – psychiatry’s got its feet under the table and it isn’t moving for quite a while. Meanwhile, I’ve got a meeting coming up with my psychiatrist and that’s partly why I’ve written this – writing something about it all is cathartic in a way, but it’s bizarre for me to have to go to a clinical psychiatrist, someone who I have no belief in and know relies on so much discredited science, while lacking the ability to assess real-world situations adequately. But, even though I’m right and there’s ample evidence that I am right, I’m not only in the minority in knowing that but there’s also a legal framework – informed by dodgy science and its own ignorance – that disempowers me and any legitimate argument I may make in the face of a lot of power. There’s nothing I can do about that and that’s why I have to go.