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An investigation found that many US hospital websites were more like advertising outlets than educational portals.

This week, JAMA Internal Medicine published online an interesting paper, “Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study.” They found that exposure to anticholinergic drugs significantly increased the risk of developing dementia. This study has important implications for those who prescribe and take psychiatric drugs.

Our newest conference this coming April in Michigan is the high point of a transition that my wife Ginger and I have been making for several years. The origins of the change go much further into the past to sixty-one years ago in 1954 when I was an eighteen-year-old college freshman at Harvard and a friend invited me to join him as a volunteer on the wards of Metropolitan State Hospital. I was majoring in American History and Literature, with little thought of becoming a psychologist and no thought whatsoever of being a medical doctor and a psychiatrist.

As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past. While these approaches are not without their flaws, they are often surprisingly insightful. (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)

We live in a culture bombarded by media and sped up by rapid-fire social interactions. It's definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. "Depression" is such a word - it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar -- and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.

In order for you to understand where I am coming from, you probably need to know a bit about how I got here. Throughout my psychiatric training I had always, in the back of mind, this question: What is the difference between my suffering and those of my patients? How come they get all this treatment and I got none? Why do they have a ‘brain disease’ (there was a time when I tentatively believed in this sort of thing), whilst I, who was at times symptomatically severe enough to warrant medication, have no brain disease? The answer seems plain to me now. I had suffered exactly in the same way as many of the people I see every day do, but I had been lucky enough to avoid labeling and drugging.

Many of us spend a lifetime avoiding our emotional pain, and it does become more and more toxic as long as we keep it buried. It will literally make us ill, physically and mentally, as Bessel Van talks about in the book, The Body Keeps Score. The little quip, "What you resist, persists" has proven very true in my life. The only way out of that trap is to stop avoiding and learn in whatever way makes sense to us as individuals to feel once again and to embrace and absorb and therefore transform the pain of our lives. This is how I am healing.

The Division of Clinical Psychology of the British Psychological Society published a paper titled Understanding Psychosis and Schizophrenia. The central theme of the paper is that the condition known as psychosis is better understood as a response to adverse life events rather than as a symptom of neurological pathology. The paper was wide-ranging and insightful and, predictably, drew support from most of us on this side of the issue and criticism from psychiatry.  Section 12 of the paper is headed "Medication" and under the subheading "Key Points" you'll find this quote: "[Antipsychotic] drugs appear to have a general rather than a specific effect: there is little evidence that they are correcting an underlying biochemical abnormality."

-The findings of many neuroscientific studies are really just random background noise.

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.

  Editors' Note:  We at Mad in America have all known and loved Leonard. He truly represents the best of why we are engaged in these...

As a person who has been psychiatrized, but hasn’t faced long-term institutionalization, I have to accept that I can’t know that level of loss of power and vulnerability. (But I can tell you even short stays are enough to begin to understand.) And to be a person of color with psychiatric labels interfacing with the police? It’s like the perfect storm. (A type of ‘perfection’ that occurs more often than most, given that people of color are more likely to be diagnosed in the first place.)

With great regularity, I receive emails from people—“patients,” family members, and mental health workers—who are frustrated by this fact: the psychiatrists they meet, and the larger psychiatric community, are simply not aware of research that questions the merits of psychiatric medications. Many providers, for instance, do not know of Martin Harrow’s long-term study of schizophrenia outcomes. We at Mad in America started Mad in America Continuing Education to produce online courses that will fill in this knowledge gap. And now that we have our first courses up, we need your help.

When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know. But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.” And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.

What are Extreme Experiences? Other terms for them are Spiritual Crisis or Spiritual Emergency. With the appropriate support many find the experiences profoundly transformative. However, observers or relatives may have different beliefs about extreme experiences: perhaps that a person is having a psychological breakdown or mental health problems, or is psychotic or experiencing schizophrenia.

On December 29, Nassir Ghaemi, MD, a psychiatrist and a professor at Tufts Medical Center, published on Medscape an article titled Psychiatry Prospects for 2015: Out With the Old, In With the New? In it, he writes that with the changes in health care "Clinicians can stop pretending that relationship and social problems have to be shoved into a biological-sounding DSM category (such as major depressive disorder or generalized anxiety disorder) and treated with the only thing insurance companies would reimburse long-term: drugs." So there it is, starkly stated: Clinicians, by which he clearly means psychiatrists, have been pretending.

When I was locked in a psychiatric hospital, I wasn't able to have much of a conversation with my parents about what was going on. Phone calls were tense and filled with silence, and as I stood at the ward payphone I was so confused and frozen in fear that each call just confirmed to them how lost I was. Every day as a patient centered around the various prescriptions I was on, and like so many people suffering in a psychosis, helping me became a wait to "find the right combination of medications."

So here we go again; another meeting with another young person who describes how he is in an acute crisis - you may call it - and is diagnosed and prescribed neuroleptics. He is told by the doctor that he suffers from a life-long illness and he will from now on be dependent on his “medication.” As long as people are met this way I see no alternative than showing that there are alternatives. If that means being "antipsychiatry," then I am more than happy to define myself and our work in that way.

It is generally recognized in antipsychiatry circles that antidepressant drugs induce manic or hypomanic episodes in some of the individuals who take them. Psychiatry's usual response to this is to assert that the individual must have had an underlying latent bipolar disorder that has "emerged" in response to the improvement in mood. The problem with such a notion is that it is fundamentally unverifiable.

What are the philosophical underpinnings for what constitutes evidence and how have quantitative approaches so effectively trumped qualitative approaches in applied psychiatry, psychology, and the like? Furthermore, is it possible that quantitative ways of studying human experience may actually promote constricted, myopic views that hurt or oppress human beings? And how does this contribute to a global biopharmaceutical research enterprise reframing the understandable reactions to oppression as being the deficiencies and impairments of its victims?

Atul Gawande is a physician author whose work has been published in The New Yorker, among other places. In his most recent book, Being Mortal, he explores the complexity of end of life care. In this blog I discuss why I found this book relevant to Mad In America.

Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and, particularly in the USA, for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? since psychiatric diagnoses have been admitted to be non-valid even by the people who drew them up, professionals should not be offering people the ‘choice’ of describing their difficulties in diagnostic terms in the first place. That would still leave people with the right to adopt whatever explanation suits them as private individuals.

By their own recent admissions, establishment psychiatrists and major psychiatry institutions have been repeatedly wrong about disorder validity, biochemical causes, and drug treatments; and also, in several cases, have been discovered to be on the take from drug companies—yet continue to be taken seriously by the mainstream media. While Big Pharma financial backing is one reason that psychiatry is able to retain its clout, this is not the only reason. More insidiously, psychiatry retains influence because of the needs of the larger power structure that rules us. And perhaps most troubling, psychiatry retains influence because of us—society’s increasing fears and its expanding needs for coercion.

The International Journal of Geriatric Psychiatry published an article titled Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia,  which concludes "Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management." But the participants were not a random selection of people taking the drugs in question. Rather, they were individuals selected because of aggressive behavior, most of whom had been taking some or all of these drugs on admission. So it is a distinct possibility that the aggression was a drug effect for many, or even most, of the study participants.

It falls upon us survivors to prove that we were damaged, and that we aren’t malingerers or attention hounds or “mentally ill”— if we have any energy amidst the maelstrom to plead our case. Because if we don’t, we risk having our narratives rewritten by others’ “good intentions,” misinformed though they may be by the mainstream narrative. People get weird and pushy about this stuff, both because suffering is ugly and because our truth threatens their worldview.