Sunday, April 15, 2007

The Dialogue: Part 1

Topic: The Psychiatrized/Psychiatrist Relationship
By Patricia Lefave, Labeled D.D. (P) and Rob Wipond

I had contacted Rob Wipond for permission to reprint one of his articles, Kirby report (1):Let there be pills for all ,on my blog, Nuts R Us. He gave that permission and also took a look at a couple of things I had written regarding my own experience with psychiatry and what I had learned from that. In particular he mentioned my short essay, The Psychiatric Tautology: Our Collective Nightmare which is published on the Website of my friend Al Siebert, PhD. at Successful After reading it Rob contacted me again with a question or two.

At first, I thought, he seemed a little hesitant to ask me anything too directly, as you will no doubt be able to intuit from some of our exchange reprinted here, but as he learned I was none too shy about delivering a few answers, he and I decided to press on with this a little bit.. In this ongoing conversation, Rob asks me some hard (or blunt) questions. Before you bristle at the questions, please remember that if they don't get asked openly, they don't get answered openly either.

We who are psychiatrized are often talked ''about,'' or sometimes ''at,'' concerning all these questions. By asking and answering publicly, rather than ''confidentially'' we force that reality of ours out of the shadows and into the bright light of public scrutiny. This is something most of us as ''objects'' of observation are routinely denied; the right to speak for ourselves as equal human beings rather than being spoken ''AT'' as ''subjects'' or ''cases.'' To that end, Rob and I decided to make our private discussion a public one.

It is our hope that some others reading this exchange will get something out of it; perhaps a new idea, or a new point of view, on an experience most people do not have and, those who do, are often reluctant to discuss it with friends, let alone publicly. Who knows? Maybe Rob and I will spark a discussion that will take many of us into a whole new realm of meaning.

If you find yourself getting lost in there, maybe you should contact me. I am pretty good at finding my way out of mysterious realms and I might be able to offer you some pointers for the return trip...

Fasten your psychic seat belts. At times, this may be a somewhat bumpy ride.

Rob: On this theme you write about here, discussing the kinds of mental limitations and blinders we often see in many psychiatrists, one thing I've noticed, and you can tell me if you think I've gotten a skewed view, but after my years of looking at this, I feel like your description of many psychiatric minds could as well apply to many of their "patients". That is to say, I've noticed that many of the psychiatrists and patients who come to loggerheads with each other for prolonged periods often, ironically, underneath it all, have very similar personalities and world views. Reluctant to simply explore, question, entertain possibilities, admit confusions, let go of beliefs...

For example, many people I've seen, when they are "depressed" (and I share your questioning of these so-called clinical definitions, so I use such words colloquially), tend to be extremely resistant to doubting the negative conclusions they may have reached. Or a person "suffering" from "hallucinations" often tends to be, just like many psychiatrists, someone who resolutely believes in the unquestionable "reality" of his/her limited experiences.

And please I hope you don't take any offense or think anything I'm saying is personal or anything. This is just something I've been thinking about for a while and your article's theme really resonated with me. And I felt like you might have some interesting perspectives to offer on this.

Pat: No offense taken. I do see what you are getting at BUT there is a very important difference between the psychiatrist and the psychiatrized. The psychiatrist has almost unquestioned power over the patient, and the patient can be rendered almost powerless. This is why I also compare the relationship to "Stockholm" Syndrome: Souls Held Hostage in Psychiatry, Families and Workplaces ." It is a sort of forced co-dependent relationship from which the identified patient may be unable to escape so he or she must try to change it, somehow. Some patients identify with the psychiatrist and try to understand him, or be more like her, and others become enraged by the situation, usually after a long effort of 'trying to get through" to him. (Her) It is the difference, the imbalance, in POWER though that is what keeps this going, in my opinion. Though the protagonists may be similar, they are NOT in a similar situation are they?

I also want to add that I have personally met more people defined as "patients" who questioned ideas and were much more willing to explore than some of the psychiatrists I've known, and when a ''patient'' doesn't admit confusion, it is more likely that the reason she doesn't is because she already knows that doing so may well result in more ''medication'' as it is heard by the doctor as another ''sign.''

If the psychiatrist doesn't admit confusion it is because he doesn't want to appear unprofessional or weak or (god forbid) fail to keep up appearances. I doubt though if the psychiatrist is ever afraid of what may happen to him personally if he admits it. He is not in the same position as the patient; not even close.If the patient doesn't admit it, it is because he or she has a 'disease' that is presumed to cause that and which makes the psychiatrist right to 'treat' that for the patient's own good of course. There is a constant, and often blatant, double standard being promoted; a double standard which itself, is often then denied as well. It is like all the traits which are being discussed as 'mental illness' are, in fact, present, in one way or another, in one participant or the other, sometimes both, but are DEFINED differently depending upon who is doing the 'assessing.'

I am sure I can add something to your thought processes on this, Rob. You have probably noticed that many people think you are saying something you did not mean in the way you meant it. There is a reason for that. A constant feature of this whole thing is that the words themselves mean something different depending upon WHO is using them and on who is being identified as what. You have probably heard of experiments done by universities and in clinical settings in which students are admitted to hospital with a complaint of one supposed ''symptom'' and then after they get in, they act exactly the same as they would in their every day lives. Yet they cannot get OUT of the hospital, or out of the diagnosis, until someone comes to rescue them physically. It is exactly the same of the psychiatrized yet it is made to seem different.

Virtually anything can be redefined as a ''sign'' which would not be see that way except for the label itself which suggests to the observer of the labeled that it SHOULD be seen and heard in those terms. I have experienced this for twelve or more years myself. The most relatively meaningless ''normal'' statements or behavior gets ''interpreted'' as something other than what it is. Yet basically, I have not really changed. Other people's perception of me has changed though, and with some quite drastically.

Rob: Yes, I know a number of studies like the one you mention which I frequently cite as well. For anyone interested, here's a link to one of them. It's called "On Being Sane In Insane Places "

By today's safety standards, ironically, this kind of study, of objectively testing the criteria by which people are submitted to forced psychiatric interventions, could probably not even be attempted any more. It's far too dangerous for, basically, everyone!

As for your main point, yes, I fully appreciate it. It's all about the power, and in that sense, there's no mirror of equality at all. One side has extreme power; while the other has very, very little except that power given to him/her by the doctor and/or by the limited, particular legal means that may exist in different jurisdictions. Out of that power, all the discrete, separating definitions and labels follow. And it's interesting you note that some labelled people become, in a sense, defensive in that situation, and understandably so. An otherwise open-minded person, generally willing to at least question his/her own convictions or sanity, might become less willing to question his own convictions or sanity in front of a psychiatrist who refuses to meet him/her on equal terms. That's very understandable.

But I'm not talking about the dialogue between psychiatrist and labelled person right now. I'm talking about outside that relationship. Consider, for example, the time before and after that power relationship is fully activated. Many people I know (and some I consider my friends), have been forcibly treated not just once but numerous times over many years. And they're not stupid. Indeed, many of them speak very articulately about the oppression going on in our mental health system.

Yet when many of them start to spiral through a 'difficult time', it's almost like clockwork. You can see the sleep going by the wayside, the decent food not being eaten, the resistance to exercise mounting, the refusals to seriously consider the points of view of even trusted friends increasing almost by the minute... And most importantly, you can see the absolute conviction in their own "rightness" and "supreme sanity" becoming overwhelmingly powerful inside them. Honestly, emotionally, for me, some will sometimes seem to become as blind and rigidly fixed in their beliefs and perspectives as the worst psychiatrist.

Admittedly, they have basically no power, so they aren't equal to any psychiatrist in that sense. But they have, at least, a measure of power over their lives in those moments and it seems like they almost CHOOSE to drive headlong into a psychiatrist. And that's like a train running at a cement wall. You can warn them, "You know this system... If you're not more careful...If you don't start questioning what's going on inside you" etc. But sometimes, even with tangible assistance provided in the way they've asked, they'll still run headlong into the wall. Obviously, there are millions of exceptions and incarceration scenarios completely different to this story; I don't want to sound like I'm overly generalizing. But I've seen this type of dynamic all too often. Have you seen it? Have you seen how common it is? Do you know why it is?

Pat: I am not sure if ''Being Sane in Insane Places'' is the original study I was thinking of. In any case, I already have at least part of it on one of my blogs as a ''public service.'' I had read something on this sort of thing many years ago, probably about the same time that R.D. Laing's views were being published in the early seventies. I also mentioned this to my own psychotherapist during my recovery therapy in 1996 as I was trying to tell her, using examples she may have read herself, what it was like to be in the position I was in, as defined by other people who would NOT relate directly, no matter what I said. It reminded me of the same group dysfunction as seen anywhere else. I found it quite bizarre at the time.

The resistance to genuine, direct communication BY the people who were presenting themselves as the epitome of understanding of mental ''health'' matters just floored me. I kept thinking the whole mess was a ''joke'' much longer than I might have because the refusal to deal with the reality of the situation seemed too ironic to me to be anything BUT a ''joke.'' Since my own protagonist deliberately led me to believe my experience with him and the group WAS a ''joke,'' this was not much of a stretch for me. How could mental health professionals not see something so OBVIOUS about themselves? It HAD to be a ''joke.'' Yet I have learned that they don't see the obvious and they really aren't ''joking.'' I have heard this same sort of assessment of similar situations coming from other psychiatrized people and I think the reason is because it is too surreal to be taken seriously.

As far as being too ''dangerous'' to do these days, I am sure it is. We only have to take a look at the thoughts, feelings and behaviours being defined as ''disease process'' today to see that virtually anyone, anywhere, could easily be psychiatrically labeled. Once labeled, as I have said before, your life as you knew it is now over. For you are now one of those ''others.''There is a very good article I know of which I can personally relate to, written by a psychiatrist ( a maverick of course) and a psychiatric survivour which I would recommend to BOTH sides in this. It was brought to my attention by a friend in Minnesota as she knew it would interest me. It is titled:Identifying and Overcoming Mentalism by Dr. Coni Kalinowski and Pat Risser

The term ''mentalism'' is used like the term racism and the article also talks about the ''them'' and ''us'' mentality and something else which I think is very important in understanding what happens to an individual who is targeted as inherently inferior in some way. Dr. Chester Pierce, an African American psychiatrist, named this experience, which I have had myself, ''micro-aggression.''

I am now seen, and heard, by many people through the filter of my applied label. If I am angry, I must be having one of my paranoid moments, for my anger is no longer considered to be reality based by most of my self appointed judges, who have no qualms about spewing their opinions of me, at me, from a few feet away, while the local voyeurs stand there watching and listening for my reactions to that.Projection is also a big part of the imbalance of power in this relationship. While many psychiatrist claim they are not big on control, control seems to be the primary goal now. That duplicity is hear quite clearly by most of the psychiatrized.

So yes, I would say that that imbalance of power is a very important difference between us and the psychiatrists. The psychiatrist has almost unquestioned power over the patient, and the patient can be rendered almost powerless. This is why I also compare the relationship to "Stockholm Syndrome" it is a sort of forced co-dependent relationship from which the identified patient may be unable to escape so he or she must either try to CHANGE it, or change the psychiatrist. Some patients identify with the psychiatrist, or try to understand him (or her) and others become enraged by the situation, which usually comes after a long effort of 'trying to get through" to him (her). Often it is the SAME kind of relationship that has caused the I.P. so many psychological/emotional problems in the first place. It may, in fact, what brought the patient to the psychiatrist's office. (Or more often hospital)

I want to emphasize my use of the terms "psychological" or "emotional." I do so because I believe it is, at least in part, the failure to see human problems for what they are that is causing many more problems than it is curing. Swallowing a pill may give someone a temporary, and maybe even much needed, rest from something, but it doesn't make your life go away. It is more like trying to make sure someone has a smile on his face while he gets beat up. Not only do you still end up getting beat up, you look like a complete idiot about it as well. That seems to be what a lot of people really want though. It is as if they were saying, "Smile, while we break down your ego structure for you." For it is now not enough now to just accept what is being done to us; we are very often expected to smile and be grateful for it too.

Of course, if the patient begins to talk the talk of logic, it is heard as "signs and symbols" more often than not. Sometimes it gets defined as the "manipulations" of the patient. You see, the psychiatrist can't see the things the patient sees from HER point of view and there is no reason why he SHOULD since it is not his experience. The problem is the psychiatrist often believes he DOES understand it because to HIM, it is all just deluded nonsense anyway. That is what the psychiatrist believes he KNOWS.

If you, as a "sane" person, are confused about something, the assumption is there is something to be confused about. If I, as a labeled person state I am confused, the psychiatrist (and others as well) is likely to nod knowingly to himself, "Ah yes, she is 'confused' another 'symptom' leading me closer to my looming, expertly delivered, diagnostic label." Of course the doctor tends to keep his assessment to himself since you can't really talk to a "disease process" like me anyway.

R.D.Laing talked about a communication problem too and there is one, but it is not all "accidental." The whole world is not operating in blind error with good intentions. Some people's intentions ("some" not "all" or "none") are to enjoy what they do. In fact, this communication problem has now been built right into the system, and it, (and it IS an "It") is constantly looking for ways to plug up any possible escape routes.

When individuals can't be heard, no matter what they say, do or feel, the flight or fight response kicks in. If you are KEPT from EITHER fighting or escaping, what do you think happens next? Frequently, what happens next is the breakdown of the individual. When you are the told your breakdown is "proof" that you are inherently defective, what does that mean to your identity as a person?

I used to say to people, "I am a person" but I was saying it to people who could not "figure out" what that meant! Some even thought that the fact that I "thought" I had to keep telling them that was a hilariously FUNNY "symptom" of mine.As far as being "given" power goes, power that is bestowed generously upon me as a reward isn't my power. It is more like patronizing contempt. I already have my own power. I don't need to be "gifted" with it. I just need those "superior others" to stop trying (and succeeding in trying) to take it away from me. The same power dynamic can look very different depending upon your point of view. Are you; the powerful one, the one rendered powerless, or one of the third party observers? Believe me how you experience the same event matters a great deal. So, "defensive" seems pretty normal to me when it is the psychiatrized one who is being defensive. We humans defend ourselves much harder when we have less and less of our own left to us to defend. The small things then become extremely important. When I see someone breaking down into psychosis and still fighting to defend his or her identity while it happens, I tend to think, "Good for you; that is the 'sign' of a very strong spirit and this one may just survive this thing and pull out of it again despite all odds, to become stronger than ever."

I would like you to consider something else Rob. What if the psychiatrized person's convictions are really right and don't need questioning? You know how that sort of statement is often dealt with? It is often defined as another 'symptom' in the psychiatrized or, it may earn him a new label when it is judged as "manipulative" by the psychiatrist.
It often amazes me that psychiatry, as a profession, has such disdain for "manipulative" people, while the next topic for the World Psychiatric Association in Dresden Germany is "Coercion" and I don't think they mean, "Ain't we just awful for thinking like this while we teach "others" (them) how awful it is to think like this"?

If my last psychiatrist had been a different one, I too may have been forcibly "treated" and my fight may have taken a different turn, or perhaps, I may have been one of those who carried out the suicide I once considered as my only possible escape. I can tell you this; after this experience, I would never tell a psychiatrist NOW, that I felt suicidal as I know it may well only get me forced to take more drugs as a "solution." I would now be very careful WHO I told and it would be more likely to be survivours, and/or the "mavericks" of the mental health profession. Certainly, it would not be any of the A.C.T.ors.

The dialogue between psychiatrist and psychiatrized is usually not the first relationship of that style. Often, the psychiatrist assumes a power role that was previously held over the psychiatrized by someone else in his/her life. For the identified patient (I. P.) the situation is very often a repeat performance of a relationship dynamic he or she has ALREADY been struggling to escape. All of the warning bells start to go off and the shields go up.

Why are some of the friends you refer to forcibly treated? I would like to hear the exact nature of this "difficult time" when that spiral begins but, I want to know directly from the one psychiatrized and NOT from anyone else's "interpretation" of the I.P. A HUGE part of the breakdown is directly related to psychological/emotional isolation and the cumulative effects on the individual of the "micro-aggression" of a group of participants who involve themselves in it. Others act as our unwanted and unneeded "interpreters," still others as amused or supposedly detached voyeurs. I even said that once, "Am I not speaking perfectly clear English." (To the English speaking listeners) I do not require an interpreter. "Talk directly to me," I repeated over and over like a frustrated parrot.

As far as the difficult time goes, it is ALL a difficult time. It's just that for part of the time, the isolated individual is under peak periods of pressure, both external and internal, as he or she tries desperately to find the conceptual "key" to the whole mess that will make sense of what is fundamentally a senseless GROUP experience. The flight or fight response is then in high gear.

When we are breaking down, our minds go into this high gear, attempting to sort out all of the contradictions of the event before we lose ourselves completely. There is a need to escape; a panic if we cannot while more and more pressure we cannot bear is applied in the name of "help." We KNOW there is information missing which we need to understand it; but we can't FIND it. And no one helps us to do that. It is quite the contrary. They are too busy either keeping themselves from being blamed for anything, or else projecting their own belief system onto us so that THEY can make sense of an event, in their own terms, they don't understand either! What they are projecting as their own way of dealing with it, is, as often as not, a load of self serving crap.

When we are in this state of pre-breakdown, being told by someone to sleep or exercise seems laughable. It sounds like someone is suggesting we plug a dam of emotion and massive amounts of contradictory information with a piece of bubble gum. Even as a trusted friend, your point of view as an external observer is not the same. If you haven't experienced it, your understanding of it, no matter how empathic you may be, has its limits. That's not to say I don't have a great deal of respect for people like you, Breggin, Szasz, Bob Whitaker, and a whole host of others who fight with us. I am often amazed by this level of empathy in people who have NOT had the experience personally. Still though, your experience falls short of actually being the one on the receiving end of the label and all of the assumptions and judgments that come with it. Observing the target of "intervention" or abuse is not the same as BEING the target.

As for the "rightness" it is almost necessary, and quite predictable, as a psychological, self defensive, counter balance for being constantly told one is "wrong" in all one thinks, feels, perceives and experiences. I think the system would find that if it gave up its OWN invalidation game, its No-One-Must-Be-Blamed game, then that polarized REACTION to enormous pressure, would start to disappear too. It is also true that what much of what the psychiatrized say is fundamentally right, but is not heard or accepted as such. I also think those "fixed beliefs" whether literally true, or symbolically true, are in direct proportion, and reaction, to the fixed and rigid beliefs of the worst psychiatrist, or earlier sometimes, to the fixed and rigid beliefs of someone else in a parallel relationship with the psychiatrized.

Often, the only "measure of power" the patient really has is to "comply" with the other's invalidation attempt, or at least, to appear to "comply." I often think the most "rigid" in their resistance have HUGE psycho-spiritual strength. They just channel it in a way that doesn't work, or which makes their own particular situation even worse. Much of that is because they don't understand what the psychiatrist is really doing so they don't know how to deal with that either. If they did, it is likely they would not have been trapped in the situation in the first place. Often this is because in isolation, and with little or no support, for their own reality, the person can't SEE any other way to fight for him or herself and still be able to hold onto his or her own mind and identity while doing it. Nevertheless, we can't know something BEFORE we know it and once IN the situation, no one involved is interested in being open and forthright, or in explaining their own hidden agenda to the psychiatrized. That would defeat psychiatry's purpose wouldn't it? Its purpose is to get the I.P. under control and compliant. It is not about resolution for all or really healing anything.

To suggest someone consciously CHOOSES to run into a wall of resistance is to miss an important point, and it may also only reinforce that since blaming the psychiatrized one for all of their own perceptions, experience, thoughts and feelings is par for the course. It IS the problem. Instead, what is needed is a psycho-spiritual esape route and that means validation of the psychiatrized wherever you can give it, not MORE invalidation. He or she is already totally weighed down by that.

Another thing that you and others can do that is truly helpful is to engage in active listening, without judgment about what you hear. That is not so easy to do without some practice. I will tell you something Rob that people just don't understand. Whether the person is in psychosis or not, everything he or she is saying is true on SOME level. It is either true literally or it is true symbolically or conceptually. If everyone supported the concept of mutual respect for boundaries from everyone and towards everyone else, and made achieving that state a personal goal, I believe the natural result would be that this psycho-spiritual mess we are all in, whether labelled or not, would clear itself up.

The psychiatrized do not usually fail to question. In fact, we are often accused of questioning too MUCH. We can't STOP questioning, often not even long enough to eat or sleep. We question ourselves and we question the thinking of others too. When we find our personal answer though, all that changes. The problem is the people around us perceive themselves as fundamentally "different," as "sane" in oppostion to the "insane" and in order to keep up their own grandiose delusions, they need to see the problem, not as a group "illness" but as something neatly contained within the identified patient, without any relationship at all to the rest of the world and THAT is the genesis of the isolation right there. That's is society's fantasy; not the patient's.
It is a defense of society's construction, like a childish denial of group dysfunction by the group members who don't want to see any problems or 'delusions of grandeur' in themselves.

Being the individual chosen for the role of "the mad one" feels like being pushed out of concrete reality and into an alternate reality (Alternate universe is a theme of psychosis) that has been manufactured specifically for the purpose of silencing one's complaints about being pushed out, but it gets defined as the patient's choice to "withdraw."

Basically I see this as two opposing view points all through it; equal and opposite viewpoints. The psychiatrized 'claim' they are having a real experience which is very traumatic and frightening and psychiatrists "claim" we aren't, and that we only "think" we are or that we are only "saying" we are. We fight to be heard and to be taken seriously and they fight to shut us up and promote their own agenda. That, my friend, is where the "split" reality truly exists; in that power struggle between psychiatrist and psychiatrized.

This is an ongoing Dialogue on current mental health treatments, labeled people, and different points of view. We will add to it as both of us have the time to do so. Please go to Chapter 2 immediately following this post for the next responses/questions from Rob Wipond.

To bring up ALL sections of The Dialogue together, click on the label at the bottom of any of the sections. This will work unless part of it it is being read by someone else.


Sid said...

I linked here in some roundabout way, so I can't give credit to whoever's blog I bounced from.

Just wanted to say I read part 1 and wow. I so understand all this. I wrote an article for a psychiatric paper last year stating that once I became labeled with Borderline Personality Disorder I was no longer considered human, I became my diagnosis in everyone's eyes.

I particularly like the article you linked to called "Identifying and Overcoming Mentalism" by Dr. Coni Kalinowski and Pat Risser. I plan to print that out and mail copies to my psychiatrist and therapist. I may also send copies to the head of the psych hospitals I've been admitted to over the years, as well as the head of the community mental health center I go to. I think they definitely all need to read it. Need to share it with all their staff members.

Can't wait to read part 2. From what I've read so far, you have a very interesting blog. I'll definitely be back.

Rose said...

This is good!

I got a "forbidden" message, though, when I tried to follow the "Sane in Insane Places" link.

Patricia, L. said...

Thanks Rose and Sid too. Also thanks for alerting me to the 'forbidden'' message. I will look into it.

Sandy said...

Sorry to be so late for the conversation. I just saw your article and discussion about the mindset of the psychiatric profession on Rob Wipond's website while researching Zyprexa.

I have no direct experience with psychiatrists, but plenty of experience with doctors for physical ailments, and I believe they too suffer from exactly the same tunnel-vision, pomposity and power/greed motivations that you so eloquently described.

And now, I am having to intervene (read, fight with the medical system) on my mother's behalf, a woman who, unbeknownst to me, has been used as a human guinea pig for whatever Big-Pharma wants to market for the last seven years, including Zyprexa. As a direct result of this and other drugs, she has suffered tardive dikynesia, bleeding ulcer, cracked tailbone, memory impairment, confusion, incontinence weight gain and now, addiction to a narcotic painkiller (to alleviate the muscle pain associated with Lipitor, for mild cholesterol condition). This is a partial list of the "side-effects." Oh yes, her diagnosis? The DSM IV bible category of "Dementia NOS: possibly mixed vascular/ Alzheimer's dementia," a catch-all label for which there is no precise description of evidence. In other words, a handy "out" for doctors who don't know what's wrong. The only treatment? Drugs. Heavy duty drugs. Lots of them. Our seniors homes are filled with people who've been herded into those institutions by that label.

Today's pharmaceutical treatments are the gas chambers of the elderly. I firmly believe that's how our period of time will be viewed in 100 years.

Beware everyone. Take no drugs before thoroughly researching them. Don't let a doctor bully you. Be rude if you have to. Don't let your elderly parents or relatives blindly take what the doctor tells them to take either. Better yet, do as I now do, and stay away from all mainstream doctors. You'll live longer, healthier and happier lives.