Tag: psychiatry

Posted in advocacy, Community, Late Night Thoughts, Peer Support

Your Role In The mental Health System

Posted on by alidware

This is to all my fellow psychology majors, graduates, and future students. What do you believe your role in the industry is?

To all my fellow mental health consumers, what do you believe your role is?

These are the two simple questions I have. I’ll share mine, and I ask for you to share yours in the comments below!

I am both a major and a mental health consumer, but both roles have shifted dramatically. I thought my role as a worker was to help people. I thought my role as a mental health consumer didn’t exist; I knew I struggled with anxiety, but I believed it was just another hurdle to get over, and I’d gotten over many hurdles before.

I learned my role in the industry as a worker wasn’t to help people, and that people are mostly capable of helping themselves. My role was one of support and guidance so that they may discover what they are capable of. My role has also shifted recently in this aspect. My schooling has shifted from the goal of counseling psychology to the goal of research and clinical education. I know I want to be one to bring science and empirical data to the forefront of the industry. All this glorious information is sitting there wasted because clinicians don’t take the time to read it, and because the system is built in such a way that paying for training and education is ridiculously expensive for clinicians. Research is becoming more biased and doctored and that’s obviously a problem too. I want peer support integrated. I want evidence-based treatment properly understood.

My role in the industry as a consumer has changed as well. It’s bounced back and forth between dependent and utterly independent. It’s bounced between needing professionals and shunning professionals. It’s bounced between feeling hopeless and feeling as if I’m finally healing. I also have learned that my role includes reaching out to others, accepting their help, while also letting others reach out to me.

I look forward to reading your thoughts below.

Or, catch up with me on:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciated every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in advocacy, Late Night Thoughts, psychology

Learned Helplessness In The Mental Health System

Posted on by alidware

This is a term you may be familiar with if you work in mental health. It’s often used to describe patients who have spent significant time juggling between facilities, programs, and hospitals and as a result struggle with meeting their own basic needs.

It’s no secret that decent mental health care in the United States comes with a high price tag. Community-based programs that are essential for helping shed feelings of isolation and learning social skills (both of which can be necessary for us mental health consumers) are often tagged for those with the thousands of dollars to pay for it. As someone who was working full-time and provided with decent health insurance, I was offered a spot at a program like this free of charge. Unfortunately, the company I work for is switching insurances, and I’m not positive I can work full-time right now anyway.

It’s taken a lot to find that one little place. Through consistent panic attacks, paranoia, nights of hallucinations, I finally got in contact with a hospital who patched me through to a social worker. The social worker took a week to get back to me, just to tell me she didn’t work for that department anymore. She patched me through to a social worker in a different state who found me a program in less than thirty minutes.

Since none of that panned out, since I can’t find any psychiatrists near me and can’t afford holistic care, since I’m not sick enough to be in a hospital but not well enough to be by myself, I’ve resorted to daily breakdowns. My hope for healing waned. My therapist said I was experiencing “learned helplessness.” Let me explain why I’m not and why, if you are ever told this, you should think about it just as deeply.

Learned Helplessness Comes From:

Constant struggle with no perceivable escape.

People with learned helplessness have often accepted that they are unable to care for themselves–they believe they cannot control their outcome. They have been classically conditioned to believe they are inept.

The example my therapist gave me to explain the concept of learned helplessness was that of the experiment by psychologist Martin Seligman. You may know him as a positive psychology backer, and an avid studier of learned helplessness. Seligman and colleagues administered shocks to dogs strapped in a harness in a cage. In this case, the cage represented a trap and the shocks an unavoidable outcome. When the cages were opened, the dogs refused to leave the cage even when escape was made possible. The hypothesis here is that the dogs learned to expect pain and to expect no escape.

If learned helplessness is a result of being trapped, beat down, and losing sight of escape, then the mental health system has been systematically abusing people under the guise of treatment for ages.

When are we going to stop blaming the people who experience mental illness, who are constantly being beat down, held back, vilified, rejected, for feeling hopeless? Why do professionals immediately see fault in the person (just keep trying!) instead of fault in the system of support?

Note: This isn’t to say we should rely on others to pick us up–we’ve got to also work on believing in ourselves and coping properly with our experiences. It’s just a lot easier and healthier to do that with the proper guidance and support. No one can do everything by themselves all the time.

A Possible Reason

In social psychology, there is the concept of external and internal perspectives. There is a term for this I’m blanking on. Those with external perspectives often attribute outcomes to the environment around them, things out of their control, and often come from lower socioeconomic backgrounds. Those with internal perspectives often attribute outcomes to their attributions, things like their personal drive and work ethic and come from higher socio-economic backgrounds. As you can imagine, there are advantages and disadvantages to both perspectives.

I know people on both ends. I know people who consider themselves successful and attribute that to their constant strive for “something greater”, to their hard work, to their positive thinking, without acknowledging the two-parent home they come from with successful, hardworking role models, without acknowledging the support they had in following their dreams or attending college, without acknowledging the financial opportunities they were provided. I know people who don’t consider themselves successful and attribute that to their traumas, a broken economic/social system, and lack of opportunity without acknowledging their effort has waned.

One advantage to having an internal perspective is that when hardship arises, you are more likely to take proper measures to cope. You are more likely to seek support and utilize the support. The disadvantage is you see others as not trying “hard enough.” You also are less likely to support others in coming up because if you did it “by yourself”, they should be able to as well. You are less likely to take part in the community and less likely to advocate for community-based reform. You may be one of those people who see homeless individuals as useless bums.

One advantage of having an external perspective is that you see the structure of the world around you. You acknowledge (and experience) the pain of a system designed for failure. The disadvantage is depression. The disadvantage is that you give in to what you believe is your fate and struggle in seeing the change that could be made. You are more likely to relate to others who have struggled, and you’re more likely to be involved in helping others because you know what it’s like to feel like you have no one and nothing.

Which perspective do you think most (definitely not all) psychological professionals come from?

Cognitive Dissonance

Psychological professionals are trained to see the system as something there to support and guide their clients. They also go into the profession with the aim of supporting and guiding their clients. If it feels like that goal isn’t being accomplished, it may challenge their self-concept something fierce. This leads to cognitive dissonance: the imbalance between what someone consciously believes about themselves (including their attitudes toward different things) versus how they behave.

This is where I believe professionals need to be a little softer on themselves. Acknowledge that money, attitude, trauma, self-discipline, and outside support are just a few of the things that determine someone’s success in their mental wellness. Sometimes people can’t find help, and when they can’t find help, when they are sad about that, when they are feeling hopeless and defeated and angry, those feelings are valid. The system is often not our friend and we have a right to be angry about that–because no matter how hard we try, we can’t fix that by ourselves.

No matter how much I exercise, no matter how healthy I eat, no matter if I take meds or don’t, no matter how much I meditate, no matter how much I breathe during my panic attacks, no matter how many times I tell myself the pentagram on my ceiling isn’t real, no matter what I do to cope, I will not have thirty thousand dollars a month for personalized, integrated, holistic, community based, science based treatment.

What would give me thirty thousand dollars to blow? A really, really good job. What would give me that kind of job? Mental stability. What would help me achieve mental stability? A lot of support. How do I get a lot of support? Thirty thousand dollars.

Now, there are alternatives, and the system has set this up so that in order to receive these services, you must never aim higher than them.

County services, for example, are often provided to those below a certain income limit–this includes those on disability. If someone is stable enough to get a part-time job, and that job pays ten dollars over the state insurance income limit or disability income limit, that person risks losing the services which have been most helpful to them. No one wants to risk that.

And so you have an escape route, you see, much like the dogs. You can be well, work as many hours as you can and lose your integrated services. But much like the dogs, that escape doesn’t feel safe, not after having been shocked for so long. Inside the cage, at least you know what to expect. In a twisted reality such as this, the cage actually feels safer.

There are too many factors that go into being mentally well for this one-size-fits-all system to be as effective as it purports.

Agree or disagree? Leave it in the comments below, or join the discussion here:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciate every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in psychology, science, Therapy

The Two Branches of Psychology

Posted on by alidware

If you have been or are a psychology major, or you’re thinking about becoming one, you’re probably familiar with (or will become familiar with very quickly) people riding your major off as humanities, soft-science, and asking you “bro, you gunna be my counselor now?” There’s a reason psychology isn’t taken seriously, and part of it is the narrative psychology professionals have created and perpetrated. Let me explain.

Having been this major for a while now, I see two very distinct branches of psychology: the humanities side that dominates the media and is what everyone thinks of when you say you’re majoring in psychology, and the science side, which rarely ever makes the media unless the research hasn’t been peer reviewed and the researcher is money hungry.

Earlier in the year, I wrote a series called “Is Psychology a Science?” which you can read the first of at this link. We concluded there is a lot of science and that the problem is it isn’t being taken seriously, or it’s purposefully being subverted.

The Perfect Example: Gabapentin

At work, I’ve spoken with plenty of people who have been prescribed Gabapentin for anxiety or depression or as a PRN (as needed) medication. After a panic attack which I mistook for an allergic reaction to a medication, I ended up in Urgent Care and was prescribed Gabapentin “to make it through the weekend” because it’s “really great for anxiety.” I picked up the prescription (with insurance, it only cost eighty one cents, kind of how Percocet only cost me one dollar, and no, I don’t have high tier insurance) and got straight to work.

Gabapentin is FDA approved for treating Seizures and Postherapetic neuralgia (nerve pain, particularly after Shingles). It is often prescribed off-label for anxiety (usually social phobia, GAD, panic attacks, and generally worry), depression, insomnia, neuropathic pain related to fibromyalgia, regular pain, just pain, migraines, any headaches that could probably go away with aspirin or time, as a replacement for benzodiazepines (Ativan, e.t.c), as a replacement for opioids (oxycodone, e.t.c), alcohol withdrawal, benzodiazepine withdrawal, alcohol treatment (reduce drinking or sustain abstinence), bipolar disorder, any mood disorder, any perported mood dysfunction, restless leg syndrome. It can be taken as needed or daily. It belongs to its own class of drugs: the gapapentinoids. Another drug you may recognize from commercials that belongs to the gabapentoid class is Pregabalin, a.k.a Lyrica.

Anyone remember Lyrica commercials? God. Disturbing shit. I don’t watch television anymore, only streaming services, so I haven’t seen a pharmaceutical ad in a while. I don’t miss it.

What Does Research Say?

I didn’t take the Gabapentin because research told me what the doctor didn’t, or couldn’t: there is no robust evidence supporting Gabapentin for any of the off-label prescriptions above. My first indication of this came from a Vice article, which I was hesitant to read because, well, it’s Vice. So I took their investigative journalism with a grain of salt and used it to guide my database research. Here’s what I learned:

  • Parke-Davis, the company that funded research and research articles for Gabapentin purposefully avoided publishing the disappointing effects of Gabapentin. They tweaked the research to appear positive. This was found out in 2009, when researchers looked more carefully at the articles more carefully.
  • David Franklin, biologist, started working for Parke-Davis in 1996. He quit three months later, just after an executive “allegedly” told him: “I want you out there every day selling Neurontin. We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money.” You can read more here.
  • This was all in the past, and Parke-Davis paid 420 million in restitution for violating, in the most disgusting way, psychological and biological research. The problem is, the rhetoric that Gabapentin is a “great drug” and “works well for anxiety, depression, and your momma’s broken hip” still permeates the medical world. Particularly the psychological one. This was done purposefully.
  • There is no substantial evidence for any off-label use. I searched the databases all this morning. I found one measly Meta-Analysis (review of multiple studies studying the same thing, analyzed statistically) that showed 7 studies using Gabapentin for alcohol use reduction or abstinence. It was better than placebo slightly, but “the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking.” So, it didn’t stop drinking or help withdrawal, it just kind of made people drink less. Or mix the two. Which is even more dangerous.
  • The only research with Gabapentin and anxiety says it’s not substantial enough to help panic attacks and that many people are most likely experiencing a placebo effect when they take it. Given that I learned that, I saw no point in trying Gabapentin: the chances it wouldn’t work for me because I don’t believe it will was too great. When I checked my college’s database, I went through over ten pages of articles and didn’t see one study geared toward Gabapentin and anxiety.

What Does This Have to do With Psychologists?

Well, the same rhetoric permeates the clinical psychology department of the world as well. That is, psychologists are more likely to trust the word of their colleague than to go read a primary research source themselves, scrutinize the methods, results, and read the confounding variables. Human beings are naturally trusting, and that is a beautiful thing. It gets us into a lot of trouble though–most likely a colleague hasn’t read the primary research either, and is simply going off what their colleague told them.

Believe it or not, this is a research topic in psychology.

I came across this analysis in my searches this morning. In summary, the researchers did a qualitative analysis of different psychologists in private practice, and their attitudes toward things like empirically supported treatments. What did they find?

  • Psychologists are “interested in what works.”
  • They were skeptical about using protocols described by the treatments proved to work.
  • They were worried non-psychologists would use those treatments to dictate practice (which I’m having trouble seeing as bad).
  • Clinicians mostly used an “eclectic framework”, meaning they drew from many sources (most of which were probably not supported by any empirical data, I’m guessing.)
  • They valued: experience, peer networks, practitioner-orientated books, and continuing education that wasn’t “basic”. So, nothing that involves a Starbucks drink I guess.
  • If resources for learning empirically supported treatments became easier to access, they would be interested in implementing them into their practice.
  • Money, time, and training are all aspects which have been preventing psychologists from actually implementing researched practices into their treatment. 68% cited this as a major issue preventing them from adhering their practice to researched methods. 14% said it was because they just didn’t believe in the efficacy of the treatment and 5% said it was because that treatment wouldn’t fit a cliental population. Again, that is a belief, not a fact.
  • Only 19% of psychologists surveyed around the nation (United States) used psychological research papers as their primary source of research information. What the fuck are they reading? The Key To Beating Anxiety by some random self-published author on Amazon?

The analysis is much longer than what I’ve listed here, and gets deep into some real topics anyone considering going into clinical or counseling psychology should pay attention to. The message to take away here is that attitudes and beliefs are driving how we are being treated both in the psychological world and the medical field. Physicians fall prey to the “word-of-mouth” about drugs in the same way psychologists fall prey to the “word-of-mouth” about treatments. This is why I write these articles: it’s up to the consumers to play an active role in what they are putting into their body, how, and why. It’s also up to the consumers to be informed in treatments, ideas, and beliefs.

Otherwise, you’re giving your life up to someone who may not know what they’re talking about any better than you do.

Lastly, let’s get something straight: I’m thankful for every medical professional I’ve ever come in contact with, because they’ve all taught me something for better or for worse. I’m thankful for the front-line workers who have spent the last 8 or 9 months using insanely inventive strategies to try and keep their worse Covid patients alive. Doctors are reading researched evidence because the links to research are suddenly in the media, and researchers are putting out what works and what doesn’t, as they should always be. This scramble to beat Covid has stirred probably the most ethical (and probably also the most unethical) research that’s been done in a while.

It suddenly makes sense to do things right when your life is at stake.

The point is, stay informed, stay healthy, and read.

Agree or disagree? Leave it in the comments below, or find me here:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciate every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in Peer Support, Questions for you, science, Voices

What’s Your Ideal Treatment?

Posted on by alidware

I think one thing that frustrates me the most about mental health treatment services today is that the services available are shoddy, expensive, and instead of being tailored toward the individual they’re tailored to the diagnosis.

For example, if you walk in to your average psychiatrist and say: “I have a diagnosis of Schizophrenia. My mom just passed and I’ve been struggling a lot at work. I haven’t had to be on meds for a while (or, I’m on a low dose of meds, or my medication usually works), and really I’ve just been struggling with anxiety. I’m shaking a lot and I think I need some help. What do you suggest?” Chances are all your psychiatrist heard was “schizophrenia”.

It’s better to leave the diagnosis out of it.

I use this example because I can empathize with it. My most recent psychiatrist, for example, couldn’t get it out of her head that I hear voices sometimes, even though I said my voices and I are on pretty decent terms compared to what others struggle through. For me, they aren’t 24/7, they are a mix of inside my head and outside of my head, aren’t very commanding, and I gather comfort from their perspective sometimes. I am not overly attached to them. What I went to her for was anxiety and mood issues, as my official diagnosis is schizoAFFECTIVE. She seemed to remove the affective part, completely ignored the fact that a death close to me unhinged me (she said “Oh, that’s tough”, and moved on), and continuously tried to medicate my voices instead of focusing on ways I could help my anxiety–the reason I came to her.

Mind you, through all of our appointments, she never once asked me what my voices are like, what I think about them, how they respond to me. The reception staff messed up on my insurance and suddenly I owe them money I don’t have. Every time I email her for a simple question, which could be answered in an email, she wants to set up an appointment so I have to pay for it. This is why I stayed away from mainstream mental health.

But it’s not just that.

Studies show residential, communal, and peer support services are, dare I say, essential for growth and recovery, and yet you’ll be hard pressed to find any of those services affordable, available, or promoted in your area. I work in peer support, and I didn’t learn about any programs until I got a job there. Doctors didn’t know, therapists didn’t know, and of course it would be much too hard for them to do their job and help me find something.

Maybe this is just a California complaint.

There are wonderful communal options and residential facilities, places where true growth and opportunity are available . . .to those who can afford 35,000 dollars a month.

My point here is not a rant. My point is that mental health treatment has gone from ice baths in asylums backed by half-assed scientists to money traps and one-size-fits-all cardboard boxes backed by people with degrees who haven’t read a psychological research paper since their undergraduate research methods class.

We’ve dropped the ice baths, the asylums, AND the scientists.

Don’t you think this needs to change? What would you change? What is your version of ideal treatment? Leave your comments below or come to my instagram and join the discussion!

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciate every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in advocacy, science

How Important Are Your Psychiatric Medications?

Posted on by alidware

This question is for all of us, including myself, without much judgement. There are those who quit their medication and are fine, those who quit and are not fine, those who want off but are worried about withdrawal (which can trigger an upswing of serious symptoms again), and there are those who want off but their doctors disagree.

For those with any diagnosis related to psychosis, one thing you’re told especially is to stay on your meds. The reasons for why are a little less clear. This is what research says.

The Papers:

I found two articles on this topic, both Meta-Analysis (they’ve collected a group of studies and used statistics to quantify the average results of all the studies)

They both discuss studies assessing whether long term antipsychotic treatment maintains sufficient and healthy remission for individuals experiencing first-episode psychosis. There are two conclusions you will often find when searching databases for this kind of research: 1) long term medication works and 2) long term medications interferes with progress. One of these analyses kinds of lands in the middle, and the other is 100% supportive of medication.

We’ll discuss possible reasons why both valid analyses come to such different conclusions, and what this means for us.

1. Maintenance Antipsychotic Treatment Versus Discontinuation Strategies Following Remission From First Episode Psychosis: Systematic Review.

This analysis follows studies which look to understand the risks of maintenance (Long-Term usage) compared to risks of discontinuing medication AFTER remission in first episode psychosis. Seven studies were included.

Now, they looked for specific things, particularly comparing hospital relapse rates and hospital admission rates of those First Episode Psychosis individuals who maintained antipsychotic medication to those who were discontinuing their medication. For the studies which used an intermittent treatment approach, the participants medication was discontinued by 50% every two weeks. For those exhibiting prodromal symptoms, medication was reintroduced. In the crisis-based approached, medication was only reintroduced upon a full-blown episode.

Ultimately, higher relapse rates and hospitalization rates were seen in those discontinuing medication.

Two of the studies provided information on psychosocial outcomes like employment status or quality of life measurement.

I encourage you to read the analysis for yourself. I found it shocking that things like an individual’s place in society, their level of function in their community, their sense of purpose, the amount of support available, was not included. Yes, medication discontinuation seems to increase the likelyhood of relapse according to this analysis, but what could be the reason for this? Only medication? Or what about lack of support? What about the fact that tapering off medication with 50% of the dosage broken down every two weeks is indeed quite fast? Perhaps the speed effected the results of that one study.

Another rather glaring fact which makes me worry for the integrity of the analysis is the possible bias of the authors. One of them recieved support from Janssen-Cilag (think Haldol) and Otsuka Pharmaceuticals (think Abilify). This author also was an investigator on trials funded by AstraZeneca (think Seroquel) and Janssesn-Cilag. He holds a Pfitzer (think Prozac) Neurosciences Research grant.

Another author received sponsorship from Otsuka to attend a conference, and has shares in GlaxoSmithKline (think Paxil) and AstraZeneca. The last author attended meetings supported by Sunovion Pharmaceuticals (think Lunesta).

The only inherent problem with this is conflict of interest. There are times many researchers have been caught falsifying data or misreporting data with the agreement that they would get paid extra by the pharmaceutical companies funding their research. This is also common in the world of regular medical science and was particularly a catalyst for the Opiate Epidemic. Think Purdue Pharma.

This is the largest issue medical science faces today.

2.Improving Outcomes of First-Episode Psychosis: an Overview

This overview looks at possible prevention of psychosis, which is curious in itself. You can read in the paper all the different steps and stages they present which could, with further study, advance the way psychosis is treated and/or identified in an individual. They acknowledge that despite all the preventative strategies currently in place, often people will fall back into old symptoms following their first episode.

They updated a 3-trial meta-analysis to 12 trials and found that relapse rates while undergoing preventative care strategies were, on average, lower than relapse rates of those undergoing standard treatment. However, they found that there was no substantial meta-analysis support that showed integrative preventative strategies significantly improved anyone’s potential rate of relapse in comparison to a standard level of care.

They also found that the hypothesis that each new psychotic episode “damages” the brain or is “neurotoxic” to the brain and therefore “progresses the disease” has no significant empirical evidence to support it. This hypothesis is known as the “neurotoxic hypothesis of psychosis” and I’ve heard people cite it quite often.

The overview goes on to discuss future studies and cannot conclude that any one way is the correct way. They advise against using certain medical strategies that observe and study physical illness to observe, study, and treat mental health conditions; the brain varies more so than the body in more ways than one, and to assume that both can be treated equally is pretty far fetched.

There is a lot of theory in this overview and I’m not sure how much of it could be put into practice. They discuss some ways in the article, if you’re interested, including areas of support. Accordingly, their authors were not previously supported by any pharmaceutical companies.

And so where does this leave us? We have empirical evidence that medication can halt a crisis, but it is unclear, according to the second study, if we’re simply prolonging the inevitable or helping cease the progression of something. In the case of prolonging the inevitable, it would seem more humane to let people ride through the torture and support them in other ways. In the case of ceasing the progression of something–well, it seems like we’d have more reliable and verifiable data if that were the reality.

I stopped medication because I don’t like uncertainty. And the truth of medication is uncertain. I stopped medication because I don’t like being lied to. And much of medication research and marketing is based in lies, even small ones.

This may not be the path for you. What makes your medication important to you? What makes it torturous for you? Do the risks outweigh the benefits? Would you like to discontinue them some day?

Would you like to continue the conversation accompanied by beautiful photos? Great! Follow me:

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Posted in Peer Support, Supporting Friends/Family

Who Advocates For Us?

Posted on by alidware

Because the internet is my happy place (not really, but I’m online a lot), I see a lot of what becomes popular as soon as it becomes popular. I don’t follow trends or imitate them, but I do observe and one thing I observe from the Pop-Mental-Health culture, as I call it, is the individuals who become Insta-famous or YouTube famous for expressing views about mental health.

I click on these advocates with a new hope. And every time I’m disappointed.

The thing about being a pop-advocate is that everything you say is really heard. And when you’re really heard and you say something controversial, you may lose your following and For some of these advocates, an online presence is their lively-hood.

I don’t think anyone advocates for the money–what money? You don’t get money for being positive about mental health. You may if you’re on YouTube with a couple million followers, but how many mental health advocates are there with that status? I do think this gives people purpose though, and combined with the drive to offer support and the hope of wellness to others, it becomes their livelihood.

What makes this an issue though, is if you’re a YouTuber with an okay following, your channel can blow up if you talk for ten minutes about how transparent you want to be with your audience and spill your mental health secrets.

It reminds me of Dave Chappelle’s recent acceptance speech when he won the Mark Twain award. Toward the end, he said something like “And one more thing–I’d like to say that I’m gay. Can’t wait to see what that does for my career here now.”

We almost fetishize this idea of being different. It’s become “a thing” now. The day we truly accept everyone is the day someone doesn’t need to come out and say they’re gay or bi or trans or anything on the spectrum. The day we truly accept everyone is the day we don’t have to feel the need to “film our panic attacks” or us talking to our hallucinations.

In the meantime, our greatest advocates have become a lot of professionals. Which is great–we need professionals. But they’re starting blogs and YouTube channels and talking about what’s good for us. As if they know.

I rarely see a primary source on their social media or their channels or their blogs. A primary source would be a mental health consumer.

I’m not against anyone advocating. In fact, I welcome everyone to stand up and say something about mental health. But to purport that you know what we need just because you have a family member who has struggled, or just because you spent 3,000 hours getting your license (for California), doesn’t make sense. You have no idea what we need.

You can ask us what we need. You can advocate for us by spreading the word that we are individuals who deserve respect and compassion and for the majority of the time are not as helpless as we’re made out to be. You can advocate for research. You can advocate for better understandings of psychosis. You can advocate for women whose anxiety is never taken seriously. You can advocate for men whose depression is never talked about. You can share your own experience. But don’t generalize any of that into “this is how to help someone.” Because you have no idea what’s helped.

Maybe medication has calmed your son down. Great! So you advocate for medication without understanding what that means. Maybe your daughter getting off medication has saved her life. Great! So you spread the word that medication is poison without understanding what that means.

So, let’s talk about what advocacy has turned into lately. I’ll list some things, and we’ll discuss the pros and cons.

What I’ve noticed is that advocacy has turned into two things:

From professionals, we get:

  1. Mental illness.
  2. They’re ill
  3. Mental illness doesn’t make you weak
  4. But you’re sick
  5. Don’t get mad at them. It’s because they’re sick.
  6. Anxiety this
  7. Depression that
  8. Anxiety this
  9. Depression that
  10. Oh, and there’s a bunch of severe ones we don’t advocate for. Because those people are REALLY sick and less common.

From the Pop-advocate world of professionals, Insta-influencers, Tweeters, Facebookers, and whoever else, we get:

  1. Today is another day. Let’s make it a good day.
  2. You can choose happiness.
  3. Here’s a video of me having a -Insert Mental Health Experience-. I just wanted to be transparent #mentalhealth #advocacy; followed by comments of “Omg this is exactly what happens to me, thank you for sharing.”
  4. You are not alone.
  5. We need to end stigma.
  6. Let’s end stigma by talking about how different we are and also saying we need to be treated like everyone else.
  7. #Shareyourstory
  8. #Mentalhealthawareness
  9. Anxiety sucks, but you’re not alone.
  10. I’m not my illness.

The good things about this is that at least there is conversation. Something is started. We have realized that a lot of people deal with anxiety and depression and this can help prevent suicide. We are making an attempt to remind people that pain can be temporary and that a lot of us struggle in the same ways–we’re relating to each other. That’s wonderful.

The bad thing? We’re still tied to this idea that we’re sick. We’re also tied to this idea that other people know what’s best for us. In some cases, this can be true. If you think someone has implanted a microchip in your head and you want to dig it out of your brain, someone stopping you is probably your best bet. But in terms of your care, your treatment, and how you want to live your life? No one knows that for you.

We also negate a lot of topics. We negate the trauma that hospitals cause and ride it off as “I needed to be there”. Perhaps you did. But that doesn’t mean coercion and force is the way to help you get better. We negate research that contradicts a lot of what’s being spread about mental health and these things we label as disorders. For example, the DSM 5 was many years late. Why?

Personality disorders. The only disorder that has been RELIABLY diagnosed (doesn’t mean it’s proven as a disorder of the mind) is Borderline Personality. It doesn’t really have any research backing as a disorder. The experiences are very real. But it’s speculated that has a lot to do with whatever trauma that person was put through, and those experiences being a result of the brain having to learn to process all of it.

The rest of the personality disorders? They’re rarely diagnosed reliably and there is no evidence backing them. And so the committee of old, bald, white men struggled in what to do about this for the DSM 5. In the end, nothing was really done. Subcategories and Axis diagnostic criteria were removed.

But does anyone hear about this? No. No one who needs to, at least. I cite my research professor as my secondary source of information. Could he be wrong? Possibly. But if he’s not, think about what that means.

I think it’s wonderful people want to share their stories. I share mine too. But advocacy is so much more than cheesy positive tweets, some random LCSW on YouTube talking about ways to help someone who is struggling, or people who think it’s cool to video tape their crisis or everyday struggle.

Advocacy is supposed to be about information and support. It’s supposed to be about relating to each other while also showing the general public that not everything they believe is accurate. Advocacy is supposed to also be about lifting each other up, and yet we’re divided in the mental health community right now.

I’ve been questioned on Instagram many times by those who consider themselves anti-psychiatry. I have an article on Mad In America called “A System Built On Fear”. I have labeled myself as anti-psychiatry in the past. I’ve shed all my labels now. I have no faith in the medical model and no faith in anti-psychiatry because neither relies on research or truth or science. Both have sprinkles of it here and there. But the medical model relies on the gullibility of the general public, and Anti-psychiatry relies on personal horror stories.

Both are valid. Neither are helping.

So who advocates for us? Right now, I get the sense it’s mostly professionals and family members. I hear our voices in there too, but they’re drowned out by false perceptions, media distorting research, and labels. They’re being distorted by pop-advocates who are really only catering to the medical model, and extremists only catering to anti-psychiatry.

Where do we go from here?

What do you think? Who advocates for you? How does it feel when you tell your story?

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Posted in psychology, science

Is Psychology A Science? Part 2

Posted on by alidware

Welcome back. Yesterday we touched on clinical arrogance a bit, and discovered that the real problem with it isn’t the arrogance of the provider, but the blockade it provides against learning new techniques and staying updated with proper research. I mentioned I had two examples, one was personal, and one was a more wide-scale issue. You can read about clinical arrogance and my psychiatrist visit here.

I want to start this section of the series off with the second example. We are still under my first bullet point from yesterday: practitioners most often rely on intuition rather than verified and reliable research.

One thing psychologists attempt to do is predict a client’s behavior. This already sounds wishy-washy. No one can predict behavior 100% as we are limited in our understanding of ourselves (more on this once we get to my second bullet point), but there are two main methods which are used: The Actuarial Method and The Clinical Method.

The Actuarial Method

With this method, data is gathered within the range of the target population. That data is then plugged into a formula or some charts or graphs, anything that quantifies the data in some way, and what this yields is a general percentage. That general percentage represents how likely someone is to behave a certain way given the observations of their behavior (or scores on an MMPI, or this or that). So, theoretically, and very simply put, if Johnny is experiencing a psychosis we can use this method to get a general idea of how he may behave and what the best treatment may be given the outcome of others who have experienced similar things.

In trying to predict the rate of degeneration in patients who had been diagnosed with neuro-degenerative diseases, this method was correct 83% of the time.

Why is this important? Well, one thing practitioners may need to predict, especially in the current mental health system and current mental health wards is this concept of “dangerousness”. You hear all the time that people particularly labeled with schizophrenia are dangerous, unpredictable, violent. You also have probably heard that the truth is people with mental health adversaries are more likely to be a victim of a crime than to commit one. So let me tell you why this stereotype continues to persist.

In 1999, a researcher, Liener (I tried to find the full paper, I couldn’t; when I do, I’ll link it) asked clinicians to rate clients’ based on their intake interviews. These clients were hallucinating. The providers were supposed to give an answer for which clients were more likely to become violent. He gave the same case studies to untrained, random high school students and requested the same service. Conclusion?

There was no difference in the predictions. That is, the high school students predicted the same level of danger as the clinicians did, and those who were seen as withdrawn were all rated as most likely to be violent. Research shows the opposite. In fact, when mass amounts of individuals locked in criminally insane wards were let out, 97.3% never got into trouble again. 2.7% wound up back in a hospital or prison.

It’s not the public’s lack of awareness, so you can chill on your lovey-dovey, let’s all unite instagram Mental Health Awareness campaigns. We don’t need as much awareness of experiences as you think–we need research. I’ve been saying this before I even started my college journey. Talked about it every May on my previous blog Mental Truths, in fact. Want to bring awareness to something? Bring awareness to the fact that none of the research is being paid attention to. That’s what needs awareness.

The Clinical Method

In this method, we gather data about the individual and use that information to attempt to predict what the individual will do. There is no real, clear-cut formula for this as far as I’m aware, it’s kind of a guess and check system. Kind of like taking psychiatric meds.

In the neuro-degenerative disease study, it was found that this method was correct 58% of the time. Diagnosis was generally accurate, but judgments and human error lead to incorrect predictions. I mean, 58% isn’t bad, that’s ore than half, but it’s no where near 83%.

And so we see the Actuarial method is quite effective when it comes to doing something human brains on their own can’t always do very well: predict things. We see in some Meta Analysis that there was either no difference in correctness between the two study methods or the actuarial worked better. Never once could the clinical method beat it’s cousin.

You can read more about both methods here.

And still, Practitioners insist that their expertise provides a better prediction. Again, this is what I like to call Clinical Arrogance. And maybe it’s not purposeful–as I said yesterday, they worked hard for their degrees and spent long hours accumulating all that knowledge in their head. Let’s not bash these individuals, a lot of them are very bright and are in the field to support people who really need it. They just can’t read. Kind of like the HumanCentIPad from South Park.

“Why won’t it read!” (22 second clip. Totally worth it.)

I think the most hilarious thing out of all of this is that a lot of pracitioners say they never use the actuarial method, and the majority of them say one reason is because they were never trained in it.

Jesus Christ.

Jesus Christ.

And remember now, we’re trying to figure out how much of a science psychology really is. This is a tough question, because so far we see that there are methods which meet the standards for the label of scientific. But they’re not being used, and when they are and the research is done properly, free from bribes by pharmaceutical companies and researchers looking for fame, the results aren’t given any attention. Can something be called a science if it neglects the only aspect of it which is a science?

I want to stop here and let this kind of sink in, because tomorrow we’re going to shoot to the top. We’re going to investigate how this trickles down and make some speculation to why.

It seems like everything is negative, but it’s not. We hear a lot of the positive in most psychology classes, at least the ones I’ve completed, and that’s great. But some of that is misinformation and that’s problematic. This isn’t about focusing on what’s wrong with the industry, this is about awareness. I think it’s great that people feel making a social media page dedicated to a “Safe Space” or whatever can help others–and for people who are super isolated, it probably is nice to see other people experience their pain. But that’s not the kind of awareness that’s going to shift the system. More people knowing the word “Schizophrenia” could indeed perpetuate stigma if you have no research to back it up.

In fact, why not raise awareness about the fact that the dopamine hypothesis is actually kind of a shoddy hypothesis? Why not find some of the studies that point toward the many holes in the chemical imbalance hypothesis? The ones that discount genes as the biggest player in mental health heritability? Where is the awareness of this?

Oh wait. No one reads.

And if someone does read, and they have articles contradicting me, please, please send them. I’m always looking for something challenging! I only ask that the articles either cite actual research so I can find the papers, or are the papers themselves.

Posted in psychology, science, Therapy, Voices

Is Psychology A Science? Part 1.

Posted on by alidware

That question won’t be answered in this post.

This will be a multi-part series I think. There is a lot to say here, a lot to absorb, and it’s not really a matter of opinion. That tends to turn people away, because they want their opinion heard and other’s heard. Your opinion can be heard, just know its validity lies in facts and not how much you (or anyone else for that matter) believes in it.

We hear a lot today that disorders are on the rise, specifically ADHD, Autism, and Bipolar (in children). We hear that there are all these new holistic approaches. We hear about EMDR, we hear about Mindfulness, we hear that long-term medication is the only reasonable approach for certain experiences. We hear supplements will one day replace these medications. We hear psychiatry kills. We hear psychiatry saves. We hear a mix of the two–not sure how you can both kill and save someone, but psychiatry seems to be pretty good at it.

So, how do we make decisions on what is accurate and what is not? Most of the time it’s a matter of opinion. You read something good on the internet, an article that cites specific sources and looks very professional and so you trust it. You do the same with your doctor. You hear things from friends and somehow generalize their great experience to all the population of mental health consumers and suddenly you’re an advocate for acupuncture exercising demons from the tips of your fingers and you’re not quite sure how you got there, but now you’re there and you really believe it.

The thing we don’t ask for is research. The things doctors don’t read is research.

There are about 40,000 psychological research papers published each year. The majority of clinical psychologists read 1 of those research papers a month. That’s about .03% of all psychological research papers.

So let’s talk about what’s going on. There are two main issues:

  1. Practitioners rely more heavily on their intuition than repeated, peer-reviewed research (which they haven’t read).
  2. The actual science of psychology is basically the quantum physics of social sciences.

We’ll start with number 1.

We talked in the last post about the differences between a Ph.D and Psy.D (both psychologists), MFT’s and LCSW’s. We talked about how the technique the clinician uses dictates the effect on the client more than the supposed higher or lower degree/education level of the clinician. What we didn’t talk much about is why a lot of repeatedly proven therapeutic techniques are being replaced with new fad-like “holistic” and “client-centered” approaches. There are a couple reasons and one of those reasons has to do with practitioner intuition.

They have gone through years of school. Residency for some. Internships. Hours upon hours of supervised practice (3000 for those who want licensing in my home state of California, 1000 most everywhere else). They’ve made sacrifices for this, thrown themselves into debt, worked shitty jobs, lived in cramped situations. They gave up a lot for their passion and now they can be called an expert. That means they’re, well, the expert.

It’s very difficult to read a paper that says your technique has been proven multiple times to present no significant effect on the wellness of most people (we’ll talk about this idea of “most people equating to the general population later, that’s related to my second point) and be forced to change your method of practice that you’ve grown comfortable with. It’s hard when you have to admit you may very well be wrong. It’s much easier to come up with reasons why the research may be wrong–you’ve seen the progress in your clients (confirmation bias; you want to see that, so you will see that), your colleagues are using the same techniques with great success (they may be biased in the same way, and may have not read the research), and you’ve read articles which said this technique is effective; in fact, you went to a specialized school for that technique. And so you ignore the shoddy research–there’s probably no control groups, a poor sample size/selection, not evidence of peer review, and a lot of pseudo-science talk telling you that this new discovery they’re providing you with is being “stifled” and “shunned” by the medical community.

It boils down to practitioners struggling to admit they may be wrong. Ironic considering the work they’re in.

The issue with this isn’t their pride. The issue is that by not considering the possibility that they don’t know everything, they don’t have the chance to learn something that could indeed improve their practice and the well-being of their clients.

Now, the effectiveness of clients (as much as I despise that word, it’s appropriate for what I’m talking about) is measured by behavior noted by neutral observers. To properly do this, behavior is measured before and after “treatment”.

From this scientific approach, we’ve learned that ECT has been “effective” (when effective is defined as a positive change in behavior, and “positive change” is defined as the patient’s depression lessening). But, the effects have been found to be temporary, we don’t know why it temporarily works, and it causes a myriad of health issues, most severely memory loss.

We’ve learned that CBT treats panic disorder better than no treatment, better than a placebo, and better than Alprazolam (A version of Xanax). 87% of participants reported they were free of symptoms 15 weeks into CBT. 50% reported freedom after 15 weeks of Xanax. 36% with the placebo, and 33% with no treatment–they were told they were put on a waiting list (Klosko, 1990). Now what this shows us is a couple things.

  1. CBT works pretty damn well for those struggling with panic disorder.
  2. With the simple passing of time, people get better. That’s very important to consider in this field with certain experiences.

The scary thing is a lot of people who struggle with panic don’t get CBT treatment. I didn’t, not for many years.

Now, I have two examples of practitioners believing more in their expertise than research. One is a wide-spread example, and the other is a personal experience from 10:30am this morning.

I’ll start tomorrow’s post with the wide-spread example, because there is a little background needed.

This personal experience of mine sent me in a tail spin. My thoughts today have been taken over with good and evil (not the separation of them, but the unification of it) and the spirits, the voices, have essentially been trying to thwart my success and I’m struggling with whether they’re doing it to save me or to torment me for both. They played a particular song to mock me in the store today, and there was a woman following me around, going where I went, picking products next to me just to let me know that they’re here with me again, the spirits. And so this is an example of why clinicians need to pay attention to how they speak with people.

I literally just did a panel presentation on this shit to some local mental health workers yesterday, and then this asshole comes along.

He wasn’t trying to be an asshole, I know this. He is a young psychiatrist, very kind, and struggled to find the right words to dominate me with. I made an appointment with him because the person who’d been recommended to me had appointments months out and I couldn’t wait; I’m looking for a PRN for my panic as my current techniques (CBT, and processing my emotions) haven’t been working as well lately. I want it for short-term use so I can get back on track. I am on no other medications right now.

Problem is, I was prescribed Percocet and Valium for my back two weeks ago. And he saw this.

He didn’t ask me much about myself. Which was strange; usually psychiatrists go very in-depth at the first appointment. He asked what my diagnoses had been. I told him one psychiatrist couldn’t decide between Psychosis NOS or Schizoaffective. I told him my current therapist believes Bipolar 1 with Psychotic Features (mainly because she believes schizoaffective means your psychosis is only in your depressive episodes; we’re discussing this).

In ten minutes, he says he thinks I’m Bipolar 2.

This is after I tell him about my voices. This is after I tell him I was hospitalized after the Vegas shooting as it perpetuated a delusion of mine. He didn’t ask me about the voices really, or the delusion.

The problem with his diagnosis is that psychosis doesn’t happen in Bipolar 2. That would automatically make it bipolar 1. I also haven’t been depressed in over a year, and Bipolar 2 is mainly depression and hypomania. He believes my manic episode in the beginning of college was not mania because I’d get at least two hours of sleep every day. I understand that reasoning. But it’s not a reason to conclude bipolar 2 in ten minutes.

So he didn’t believe the voices. Why? I’m not sure. He didn’t ask if they were external or internal. He asked me what they said and I gave him a couple examples. He asked me if I’d heard them within the last week. I said yes, and within the last month. I told him it’s not a constant roll of voices all the time, every day. When i’m doing well, it’s less frequent. When i’m not doing well, it’s constant.

He didn’t want to prescribe a PRN because of the Oxycodone prescribed to me. I told him I’m not using the Percocet for back pain; I have 16 out of the 20 pills left. I don’t need them. He seemed intent of giving me more Valium. I said I didn’t want Valium; it has a half life of three days and I don’t want a slight risk of physical dependence.

He suggested Gabapentin (the nerve pain and anti-convulsant that keeps being prescribed in psychiatry even though it shouldn’t be, like many other drugs)or Busbar. Both are taken daily. I said no. I told him three times SSRI medication did not work well for me, and he respected that. But he still tried to squeeze it in there, advertising it as a safer drug than Valium.

What this ended with is me with a 30 day supply of Klonopin (which I’ll use maybe once every two months??? I don’t need it all the damn time) and a lot of anger. A lot. I felt invalidated. Ignored. He was young, confused maybe, thinking I was lying, manipulative, and the voices told me that’s what he thought and I believe them. He thinks I was there for drugs and he didn’t believe my psychosis.

Who lies about psychosis?

This sprung a lot of thoughts. The store I stopped to shop in was malevolent. Class was difficult. My thoughts are not nice, they’re disorganized right now, and I’m disheveled.

But it’s an amazing example for today’s post: if you’re a clinician or a psychiatrist and you rely heavily on your intuition, you’re invalidating the tiny scientific standing psychiatry has in the medical community.

Take a day off and read some research.

To Be Continued . . .

Posted in Emotions

To Process Emotions

Posted on by alidware

When I stopped seriously blogging about two years ago, it was abrupt and painful. Painful because I missed the writing community of almost five years which had enjoyed stories and laughs and tears and memories and traumas alongside me. They were there when I got my first car. They were there when I quit each job I got. They were there when I became employed at a Peer Respite house. They were there in my largest transformations of self.

Also painful because I was cracking up. Breaking down. In the hospital, confused and somewhat oddly satisfied in my terror of life. I felt alive again in a twisted way. I felt targeted and special and immortal and genius and connected to something greater than myself.

I posted every once in a while, but lost my follower’s attention. I created a slough of new sites, but WordPress changed so much of their format that I got frustrated trying to adapt. So, I went dark.

I told myself I’d be back only when I felt secure in myself. I’d be back only when I knew I had something important to say. I have something important to say.

This journey through depression and delusion and anxiety has given me new insights on darkness. Its introduced me to the true duality of nature so described in daoism. It’s roughly coddled me into accepting not only myself but all of life.

At the beginning of the pain, before I even worked at the respite house, a voice kept telling me “dead man walking”. Considering I’m a woman, it kind of cracked me up and also simultaneously terrified me; someone, something, was coming to kill me I thought. But I don’t think he predicted my future. I think he commented on my present. I was dead. I enjoyed nothing. I faked smiles. I practiced expert avoidance. I ignored myself and my inner processes because they scared me and because of that fear those inner processes found a way to express themselves for the first time in both of our lives. That way was voices, beliefs, depressions, a mania, panic attacks, and the underlying feeling of being broken.

I could talk about childhood stuff here. I could talk about medication and homelessness and the trauma of school. But I spent years reiterating that on my previous blog. I’ve spent time reiterating it to friends and therapists. And now, I can sum it all up in one word: fear.

I feared everything, for many reasons. I feared life. I feared being sad. I feared being happy because sadness came after. I feared anxiety, I feared death, I feared fear.

I think many of us go into therapy or other treatments confused on what “processing emotions” means. I think some therapists and psychiatrists who have never really gone through that heavy process are also confused on what it means. So they blurt it because they’re supposed to, it’s part of the script.

Processing emotions for me meant more than just talking about them and feeling them. It meant not telling myself “tomorrow will be better” or “this is temporary” or “I’ll be happy some day”. It meant not telling myself “you need to get up”. It meant greeting darkness with a handshake and respecting the space it needed within me. The darkness is lonely, too.

It meant sharing my body and my mind with panic and voices and fear and setting boundaries with them; if we all have to live in here together, we need to communicate and I can’t hold the power. But neither can you.

It meant getting comfortable with uncertainty. There is no standard “life”. My experiences don’t make life worse than what life should be, they don’t make life better than what life should be because life doesn’t have a designated “should”. It doesn’t have a designated “have to”. It’s just there.

It meant veering from my psychology degree and studying philosophy, a bit of physics, and leafing through neuroscience articles. It meant studying research. It meant, for me, getting off medication, and really feeling ALL of myself.

I’m sure most people have heard of the double-slit experiment in physics. I remember hearing about it for the first time as I sat high as a kite in High School chemistry. You learn the conclusion is that photons (and other particles) behave as both a wave and a particle, given the observed interference pattern. What high school teachers don’t talk much about is that the reason we come to that conclusion and label it as a reasonable consensus is because, as of right now, we’ll never know if we’re wrong.

We can’t see a single photon pass through anything with the naked eye. And so when we don’t observe it with a camera, when we can’t see what’s happening, the photon behaves as a single photon. The camera we use to observe this particle has a tiny light. That tiny light is a confounding variable–it could be affecting the particle’s behavior. Or maybe it isn’t. But, because we can never see for ourselves with a naked eye, we’ll never know. That’s the paradox, and part of the foundation of the Uncertainty Principal.

We’ll never know. We’re limited in this life we have, and when we’re not okay with that, we run ourselves exhausted trying to fix what isn’t broken.

I’m not scared of darkness anymore. What is there to be scared of?