lAura Delano and I met at the Mad in America Film Festival around 2012. I was immediately drawn to her intense intelligence and learned more about her, and was impressed by some of the interesting similarities and contrasts between our lives. We were both academically successful teens who paid off their driving and ability on entry to Harvard. We struggled since our early teens with somewhat similar existential concerns, centered around the dilemma of being a girl of a culture that was wary of our more assertive traits. The achievements were celebrated, but there was something vague about us being confused, alienated and angry.
A few years later, we both ended up being a coincidence Trendy anatomy Immediately after publication. We both wrote to Robert Whitaker and posted a blog about Mad in America. Eventually, Laura and I were asked to speak at conferences in the US and overseas respectively. However, Laura was my junior for 30 years and approached the book from the perspective of someone whose early struggles led to years of psychiatric treatment, the subject of her memoir. I was a psychiatrist for a generation of many people who treated her.
Laura’s struggle began in the mid-1990s. This was the pinnacle of the application of the “broken brain paradigm” to children. As I got older, I escaped it, but my stay in psychiatry was related to my own struggles. As an unfortunate medical student, I discovered psychoanalysis and thought it would help me understand my problems for a while. Despite our different paths, our experience has led us to develop deep criticism of my profession for both of us.
Laura and I remain friends. We once traveled together to a bookstore in Middlebury, Vermont. Anatomy. I was keen to read her books, Unshrunk: A story of psychiatric treatment resistance, And while I thought it was interesting, I wasn’t prepared for the powerful effect it had on me. In my life there was a time when blogs seemed to flow from me, but in recent years I have been experiencing much more difficult things to write about. Still, to honor my friend, I would like to share some reflections in her book.
In 1996, when Laura met her first psychiatrist, she had encountered a profession that had undergone radical changes over the past decade. During that time, many new drugs have come to the market. When I was a psychiatric resident in the early 1980s, psychopharmacotherapy was more conservative. Polypharmacy was generally discouraged and was thought to have been shown only in more extreme cases. Even in the areas I worked, treating people diagnosed with schizophrenia – even where medication was considered essential, the most respected psychiatrists in the United States were urging them to use the lowest possible doses.
It changed as newer, safer drugs were approved and strongly promoted. Overcoming changing perspectives and observing the separation between academic and publicity literature has led me on a path to important psychiatry.
Laura was diagnosed with bipolar disorder. In addition to the growth of new drugs, there was the growth of new diagnoses. Previous bipolar disorder, previously known as man depression, was applied to a narrow group experiencing dramatic extreme moods and energy levels, scattered with periods of fairly normal functioning, but now it has been applied to a much wider range of people.
Several types of bipolar disorder have been proposed, including bipolar II disorder, rapid cycling bipolar disorder, and childhood onset bipolar disorder. As a medical student, I remember the first time I met someone who had been an ex-human being a maniac. I didn’t need any kind of training to observe this person talking very quickly and jumping from one topic to another.
But a few years later, as an experienced psychiatrist, I had never grasped rapid cycling bipolar disorder or bipolar II disorder. Humans have a fluctuating mood. It has always been difficult for me to identify between mood changes considered “normal” and mood changes that could guarantee a diagnosis of one of these newer versions of bipolar disorder. I’m not a child psychiatrist, but I remember reading about the criteria for assigning a diagnosis of bipolar disorder to a child when his or her child was younger.
My point here is how the psychiatry profession has come to conceptualize human suffering. Laura talks about psychiatry as a cult. I will discuss this, but I think psychiatry provided a paradigm that our society has adopted widely. While this paradigm has its advantages, there are also issues and results that are worthy of critical investigation. Laura’s memoirs are evidence of their negative consequences.
One of the persuasive themes of her book that I have not been highlighted in other reviews is Laura’s account of how adopting a medical formulation of her problem led to the loss of her agency. She was a “good” patient. She accepted a diagnosis of bipolar disorder and (mostly) followed the psychiatrist’s recommendations. She was a product of the age of “broken brains,” which gave rise to the notion that, due to the forces outside of her control, her brain was not functioning properly and manifested as the problem she was experiencing.
For Laura, it meant she was waiting for healing to come from an external source. As Laura explains in her book, there was one psychiatrist trying to challenge this, but she wasn’t ready to hear it. She began to find her agency through her participation in AA and continued to grow over time. Is it fair to blame the entire psychiatry profession when Laura herself was conspiring to what happened to her?
In my experience, the intense promotion of the “broken brain” model has become so entrenched in our society that it has made it difficult to consider the counter story. It was provided in part to reduce stigma and to alleviate people’s responsibility and shame. But it was done with confidence, especially in the 1990s, about the “Decade of the Brain.” I would recommend there is another path. This is where an attitude of uncertainty and humility is embedded in the profession.
This is one reason why I am attracted to approaches such as open dialogue where multiple paradigms, including those seeking care, are not only considered but also evaluated. This is also why I, along with Laura, am attracted to Joanna Montlief’s drug-centric approach. It can talk about medication as a way to improve some aspects of people’s experiences without embodying the psychodiagnosis that is thought to form the basis for rest.
I know many psychiatrists who respond to the story of Laura and others like her, saying she is misdiagnosed. It suggests that a wise and all-knowing psychiatrist has made the “correct” diagnosis. Misdiagnosis as an explanation of fallback constitutes a retrospective correction that assumes that when things don’t go as expected there is a “correct” method from the start. Diagnosis should always be considered a guide to suggest hypotheses, tentative thinking about human problems, but not dictates, but is a potentially effective treatment.
It’s difficult to have these conversations without telling someone who “has” what you have positively identified. The only way to alleviate this is to make it very clear from the start that psychodiagnosis is a label aimed at serving a specific purpose. They may point to the path to useful treatment, but they are essentially heuristic components rather than a definitive explanation or understanding of clinical issues. In my experience, the act of providing a diagnosis has a great impact on a person’s sense of self, and its limitations must be repeated over and over.
We observe this in Laura’s story, looking back, that some of the psychiatrists have claimed (and even recorded) the uncertainty of their diagnosis. Both can be true. The psychiatrist may have mentioned this and Laura had not heard of it. This is not intended to blame Laura. It is intended to emphasize how powerful diagnostic labels are and the recurring importance of exploring their meaning and effectiveness on those they are assigned to.
Laura stopped her medicine and learned at least two things. They are difficult to stop and there is limited knowledge about this within medical institutions. Millions of people turn to the internet to find answers as psychiatrists do not acknowledge the validity of their experiences withdrawing from these drugs. The roller is not an outlier. After years of advocacy, there are guidelines in the UK for tapering drug doses. As Laura writes, this topic is barely recognized in the US. why?
in New York Times article Referred American psychiatrist Allen Francis details what Laura and her husband, Cooper Davis, do with the inner compass.
What makes so much sense for Laura is that for millions of people who are overdiagnosed or overtreated, it doesn’t make any sense to those who can’t get the medicine. …Laura is not generalised to people with chronic mental illnesses, and it is clear that she may end up in the homeless or hospital. … Those people don’t look like Laura when they’re taking medication.
I think there are people who do it more when taking medication. I still work as a psychiatrist and prescribe psychotropic medications. But Allen Francis admits there are millions like Laura. The other way between Francis and I is that I don’t think it’s easy to distinguish between those who benefit from them and those who don’t. First of all, the alarm embedded in his statement risks stopping discussion. Most people who have stopped taking psychotic medications are not homeless or hospitals.
Furthermore, drug taper doesn’t have to be synonymous with drug disruption. In my experience, approaching this, it works well even with the harm reduction model. They attempt to minimize the risk of medication by minimizing doses, but this does not necessarily mean that treatment is discontinued. Rola discusses the hyperbolic shape of the drug receptor binding curve. This explains why the final increments of drug disruption tend to be the most difficult. I have worked with people reaching low doses (sometimes mistakenly considered “subterapeutic”). At such doses, the adverse effects are significantly reduced.
Continuation of medication at low doses can be guaranteed for many reasons, but is particularly continuous uncertainty to the extent that reduces the risk of recurrence. However, this is the perfect choice for a partnership between an individual’s intake and those who prescribe drugs where known and unknown are openly recognized.
Psychiatric occupations should consider the consequences of expanded applications of diagnostic categories and the resulting expansion of drug therapy use. We need to consider the fact that the alarm went up at least 30 years ago, and that it was largely ignored, at least 30 years ago, for the issues that arise as As. result Drug interruption. There was a mistake. By us.
We live in an age where expertise is devalued and scientific research methods are seen with doubt. I continue to support the importance of scientific research as a process of its greatest strength, acknowledging the tentative nature of its formulation. When socially powerful professional institutions do not acknowledge the limitations of manifesto and seek to ameliorate their obvious failures that violate the fundamental spirit of scientific methodology, they contribute to the erosion of public trust in expert opinion.
