When psychiatrists have no sense

March 24, 2015 by

More Treatment = Less Stigma | Psychology Today
【from Next Browser】

Someone once told me to be careful about what I told people I know lest I demonstrate too clearly how much I didn’t know. I think that should be the topic in the very first class that psychiatrists attend in how to be a psychiatrist school. Sometimes I despair when I read their descriptions of life. It is too often a color blind person trying to tell you everything is really a shade of gray. For a science that in the scientific sense actually knows very little they have an amazing propensity to tell you they know everything. And too often, at least it seems to often, what they say would be dismissed as worthless tripe if they didn’t have the title of doctor in front of their name. And so we have the article above.

I have read a lot of posts about stigma. Some think it is real important. Some think it is not. Some I agree with. Some I don’t. Some are really involved. Some simply say it is prejudice and discrimination. Some of the posts are very thoughtful. One is embarassingly, thoroughly embarassingly stupid. That is the post linked above.

Until today I, like I think many people, had never heard of the author. DJ Jaffe posted it on Facebook with some kind of comment about the remarkable insight of the author. I thought that comment was the only remarkable thing about what I read.

If you have not by now go back and read the post. You might not want to read it on an empty stomach, but do read it.

Before I talk specifically about what he said I wanted to share perhaps my strongest reaction. If you were to substitute the word “black” or “hispanic” for “mentally ill” would his entire statement not be dismissed as blatant racism? At best is his statement not baseless stereotypes and indicative of a deep prejudice against the people he claims to serve? You tell me. Am I overstating my case?

He writes:

The larger point is this: Stigma is a mark. Something physical. Something that sets a person – or group – apart from the rest. It is NOT the reaction of others to that mark. Society’s often bad reaction to those with serious mental illness is simply the symptom of the problem, not the problem. The root of the problem is the mark, the stigma.

Then what is the true stigma of serious mental illness? The mark? It’s the often bizarre, psychotic, violent behaviour of those so afflicted. This is what marks the serious mentally ill. This is what causes the public aversion. This is what we should be spending money to correct. People will never tolerate bizarre, violent, psychotic behaviour. Never have. Never will. To think otherwise is tragically naive.

Is he not saying the “mentally ill” bring it on themselves? Is he not saying something like “they wouldn’t be treated so bad if they weren’t so crazy”?

Is this guy an aberration? The “new asylum” folks are certainly much more polite but is their not a commonality amongst them? Isn’t the common message “those mentally ill people are just different than the rest of us.” Isn’t all this kind of a rationale for oppression and injustice? Again draw your own conclusions.

When psychiatry is used as social comment do you ever wonder how much sense there really is in psychiatric sense?

There is in Tennessee… on new life for Insure Tennessee

March 23, 2015 by

There is in Tennessee the making of a revolution, a journey to health care justice awakened by a choice made to deny 280,000 of our most vulnerable citizens access to even basic health care, and stoked and brought to boil by the death of Insure Tennessee in a special session marked by political partisanship and petty maneuvering. Insure Tennessee was killed without even a full vote of the members of the legislature and thousands of people saw their hopes stolen by political rhetoric. One veteran legislator described it as “simply mean.”

In the conventional wisdom a bill voted down is dead and fighting the system is simply not done. Since the special session thousands of Tennesseans have made thousands of contacts with their legislators asking that Insure Tennessee be heard again. Phone calls, emails, visits……for many the “special session” never ended. And it is having an effect. The 7 senators who voted to kill Insure Tennessee the first time around have tried to tell everyone the are the “victims”, not the 280,000. People are mad. They are really far more than mad. More time, more effort, more energy has been given to a bill that was supposed to go away than has been given to many bills still under consideration. The people have spoken. They have spoken loudly. And perhaps they have been heard.

A courageous senator, Jeff Yarbro, has reintroduced Insure Tennessee and it has made it through the first subcommittee today. Republican senators Doug Overby and Richard Briggs stood with Sen Yarbro and the first step was taken. It goes before the full committee on Wednesday.

It is essential that between now and Wednesday that there be an overwhelming groundswell of messages to all legislators but particularly those on the Senate Health Committee. “We want a vote on Insure Tennessee. We deserve a vote from the full legislature. 280,000 deserve a full hearing. Insure Tennessee brings justice to thousands at no cost to the state and the state can back out if it is not working. It is a win for everyone. Vote yes on Insure Tennessee. Vote yes for Tennessee.”

No one is going away. No one is going to quit or accept anything other than victory. What has been awakened will not be easily be put to sleep again. Your voice matters. Make sure your legislators know what matters to you.

It is so much, so very very much, time to insure Tennessee. It is time for Tennessee at its best. It is time for Tennessee for all Tennesseans!!!


March 23, 2015 by

HSRI Newsletter – March 2015
【from Next Browser】

15 miles…. many more to go

March 22, 2015 by


15 miles.  I walked the last leg of the “journey to justice” today.  Many have walked much further. The “journey to justice” was a walk down the roads and rolling hills of 5 rural east Tennessee counties, in a state where the failure to pass Insure Tennessee has left the rural health systems in particular in disrepair and danger.  My feet hurt.   My legs hurt.  I feel far older than I am.

I walked the last mile today but it was no where close to the last mile to be walked.  It was no where close to the miles “walked” each day by those living in a system that denies them access to care and know first hand that every illness, every sickness is a serious one without health care.  The pain was nothing compared to the pain of 280000 who saw the hopes of Insure Tennesse destroyed by 7 senators who didn’t understand what they were voting against and had nothing to offer they were in favor of.

It was a long day but there are many long days ahead.  Call your legislator and ask them to join the journey to justice.  There are many miles ahead but the prize is real.  Tennessee for all Tennesseans.  Walk on.

Watch “Guns With History” on YouTube

March 20, 2015 by

Guns With History: https://youtu.be/1nAfWfF4TjM

The Journey for Justice to support Insure Tennessee – News – Mobile

March 20, 2015 by

Maryville man joins Journey for Justice to support Insure Tennessee – News – Mobile
【from Next Browser】

Sunday night

March 20, 2015 by

Linda and I will be interviewed on Sunday night at 8:00 on blog talk radio.  I don’t know which hero will be there.  Hope you can listen and will consider calling in.

A modest proposal: “The uninsured citizen solidarity act of 2015

March 20, 2015 by

Be it resolved:
That in reaction to public concern about the Legislative response to Insure Tennessee and to express legislative solidarity with the uninsured citizens of Tennessee and to quiet fears and concerns that legislators care little about what happens to poor people the following is to be instituted:

1.  Each member of the legislature will during the fiscal year go for 90 consecutive days go without access to any health insurance they may have.  During that period no member of their family will also be allowed to access that insurance.

2.  Should any medical needs arise they may only use the resources available to a citizen below 138% of poverty levels.

3.  Any legislator that requests it should be given a copy of healthcare resources normally used by the uninsured in their district.

4. At the conclusion of their 90 days each legislator will write a report detailing their experiences, issues dealt with, and recommendations for future policy that will be published in every newspaper in their district.

5. Any money saved in expenses saved by the state for not providing health care to legislators will be put into a special fund to help defray medical costs of the uninsured in Tennessee.

6. This act will be declared null and void upon passage of meaningful health care reform in Tennessee that being seen as proof the legislature has demonstrated a knowledge and concern with the welfare of poor people in this state.

Before any legislator has a heart attack be assured I do know the difference between reality and a joke unlike some of your colleagues.

On the living of Mike Walsh

March 19, 2015 by

I found out tonight that my friend Mike Walsh died a couple of days ago.  It has been a very very most sad night.

Mike lived in Cookeville, Tennessee about 120 miles from where I live.  He was a warrior for many things especially health care justice in Tennessee.  His journey to justice started a long time ago and because of his journey we are all further on ours.  In his death much was lost, but in his life so much was gained.

Mike was kind in the same way most people breathe: quietly, without effort or affectation.  He believed in law but thought the law should be the door to a better life instead of something in the way.  He never thought democracy was something we had but a choice each of us made by the way we lived and in every day, in everything he did he did democracy.

I first met him at a meeting in Nashville. He heard about my separation from Linda and approached me after the meeting to voice his support asking what he could do to help. Mike and his husband Bob told us anytime we went through Cookville and needed a place to stay we had one and more than once we found that true. I remember the night where they called almost every pharmacy in Cookville trying to get medication for Linda so we wouldn’t have to drive home late at night.

Meeting Mike made you thankful for you knew his friendship was one of God’s graces.

I don’t think we were especially close friends. We only met a handful of times, but Mike had a unique ability to let all his friends know they were good friends.

Mike I mourn your death. It was way before your time but want you to know what so many of your friends know. In your living were gifts that will last forever.

May God bless you forever. Peace my friend.

Thank you for so much.

A journey to justice

March 19, 2015 by

A small group of people started walking a couple of days ago in Cleveland, Tennessee.  Many of them are older.  Some have health challenges.  They are walking through small towns and rural areas in Tennessee. Today they are facing a day of rain.  Tomorrow looks the same.  It is a “journey for justice,” for health care justice in Tennessee.  They finish Saturday night in Sweetwater, Tennessee.  When they finally stop they would have walked across 5 small rural east Tennessee counties.  And somewhere close to mile 60 they will stop.  But “the journey” will be far from over.

Their walk was borne out of the rage felt by so many when Insure Tennessee was scuttled by a legislative committee that didn’t care about the 280,000 that would have been served by it, that didnt care what it meant for a hospital system going belly up in many small towns and rural areas, that didn’t care what it meant for the economy of Tennessee. They cared about political points and posturing about Obamacare.  They didn’t care about saving Tennessee.  They cried about finding a different way to do things.  There only answer was to do nothing.

Saturday I plan to join the march on its final leg.  Many of us have been on a journey for health care justice for a long time.  We have known of hopes dashed and fairness and justice dismissed as financial nonsense.  We have seen a state abandon the most vulnerable of its citizens in a frenzy of ideological purity.  Many of us have seen people die that didn’t have to.  All of us worry about people yet to die.

“The journey to justice” is a journey for all of us.  It is the clearest yes in what has seemed a forever storm of no.  It has a facebook event page that describes all the details.  If you are interested visit that page or contact me further.  I would love to meet you there.  If you cant be there please pray for its success.  Call your legislator and ask him to be part of your journey.  It is time.  Way, way past time.

The walk is 60 miles.  But we have been walking a long time before that.  And Saturday night will not be the last step.

It is, in the end, the journey of all of us and a journey Tennessee badly needs.

Walk on and may God bless each step you take.

When insurance cures

March 18, 2015 by


From the archives

Originally posted on Hopeworks Community:

She was taken to the hospital by the ambulance.  She had miscalculated and the pills she had taken were not going to be enough to kill her.  It was little comfort to her family.  It was her 3rd attempt in a very few months.  Her husband and kids just cried. They were not mental health wise, but they were losing someone they loved and they knew it. The news for today just left them with their fears for tomorrow.

She went into the hospital as she had before. As before she got the same news. Her mood had brightened. She seemed like she was doing okay and after the fifth day her insurance wasnt going to pay for any more days. She was “cured” by insurance. Her insurance didnt believe much in people, but they sure believed in pills. She had medication and more medication and finally medication to medicate…

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The Murphy attack on recovery

March 18, 2015 by

This is a repeat of an earlier post I messed up.  I apologize if it is a repeat for you.

Recovery and Recovery Support | SAMHSA 
【from Next Browser】

It is as important to know what Representative Murphy and his guys are against as it is to know what they are for. They are against Samsha. Really, really against Samsha. If you listen to the passion with which they talk about Samsha you get the feeling they almost regard it as demonic and their proposal as being something akin to an exorcism. One of Samsha’s largest sins according to them is the notion of recovery which they view as the source of all things wrong.

The link above is to Samsha’s description of recovery. Below is a major part of that description. Lets look at what Murphy and guys hope to save us from:

The adoption of recovery by behavioral health systems in recent years has signaled a dramatic shift in the expectation for positive outcomes for individuals who experience mental and/or substance use conditions. Today, when individuals with mental and/or substance use disorders seek help, they are met with the knowledge and belief that anyone can recover and/or manage their conditions successfully. This is the crux of it. Dr. Torrey has made a career of arguing against the idea that people get better. If it is possible on a regular basis for people with mental health issues to get better his niche, his territory is diminished. The notion of coercion and hope just don’t go together.The value of recovery and recovery-oriented behavioral health systems is widely accepted by states, communities, health care providers, peers, families, researchers, and advocates including theU.S. Surgeon General, the Institute of Medicine, and others. Recovery is not a fad, not a fanciful construction. It is not the creation of an out of touch elite. It is not something without evidence and factual basis. It is the core notion of a system of mental health care based on care. The old notions of chronicity led us to a system that was an obscenity to those trapped in it. Murphy and the guys don’t offer a step into a better future but a fall back into an awful past. You should at least understand what you got before you get rid of it. They don’t.

SAMHSA has established a working definition of recovery that defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. A process of change through which people improve… A process, not a product, not something you have but a way you live. It does not mean life is not hard. It means it is better. If you believe in recovery you believe life can get better. Again millions of people, even those with the most severe diagnoses have shown that it can and does. The Murphy straw man notion of recovery has as much relationship to reality as a horse drawn court has to drag racing. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. Recovery is not built upon the nefarious efforts of “psychiatric survivors” to hijack the system. Evidence. It is the result of following the facts and not desperately clinging to an ideology desperately lacking in ideas. Learn more about SAMHSA’s Working Definition of Recovery — 2012.

SAMHSA has delineated four major dimensions that support a life in recovery:

Health—overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being. Rep. Murphy, as the only living psychologist in the US Congress, do you, can you, seriously quarrel with this??

Home—having a stable and safe place to live. Abundant research says all the medication in the world, all the psychiatric hospitals in the world don’t substitute for having a place to live. Homelessness is not a defiency in treatment. It is a defiency in having a home.

Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. If you would tell me that people with “mental illness” cannot find and live a life of purpose I have to wonder how many “mentally ill” people you have actually known. Trying to tell anyone that accepting the fact that they will never find a meaningful and purposeful life because of their illness is the only realistic thing they can do is neither factual or realistic. It is one of the most hurtful lies they can be told and one of the underpinnings of the old hospital system which simply locked people up to die.

Community—having relationships and social networks that provide support, friendship, love, and hope. In reality there is no us vs them. There is only we. To try to say, that in any way, that community doesn’t matter or should not be extended to those with “serious mental illness” ignores the facts and disregards their rights as human beings.

Health, home, meaning and community….How exactly has this led us astray Rep Murphy?? Don’t tell me tales of fruit smoothies. Really how???

Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. A person’s recovery is built on his or her strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members. You seem to argue against hope. It is almost like you believe giving people hope is unkind. I have a friend who survived 24 years in a state institution. Against all odds he left as a person. He clung to hope in a system designed to kill it. He gives me hope. I am so glad he did not listen to you.

The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care, and other approaches. Recovery is characterized by continual growth and improvement in one’s health and wellness that may involve setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery. This is another key point of attack for you. Psychiatrists may play a helpful role in recovery, but recovery is ultimately not a medical notion or monopoly. In fact, from everything I can see the field of psychiatry has more and more marginalized itself as it has become more and more less and less about anything other than medication management. You argue for and defend a monopoly that never has and never can exist.

Resilience refers to an individual’s ability to cope with adversity and adapt to challenges or change. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges but also to be better prepared for the next stressful situation. Part of the notion of recovery is that we get better at getting better. People can and do regularly learn as much from what goes wrong as what goes right. The absence of difficulty is not recovery. Recovery is what you do with difficulty. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery. Visit SAMHSA’s Partners for Recovery Initiative’s Resilience Annotated Bibliography – 2013 (PDF | 531 KB).

Because recovery is a highly individualized process, recovery services and supports must be flexible to ensure cultural relevancy. What may work for adults in recovery may be very different for youth or older adults in recovery. For example, the promotion of resiliency in young people, and the nature of social supports, peer mentors, and recovery coaching for adolescents and transitional age youth are different than recovery support services for adults and older adults. Learn more aboutCultural Awareness and Competency.It is not a one note song. AOT is not the only tune worth playing.

The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. They provide essential support to their family member’s journey of recovery and similarly experience the moments of positive healing as well as the difficult challenges. Families of people in recovery may experience adversities in their social, occupational, and financial lives, as well as in their overall quality of family life. These experiences can lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery. The notion of recovery is not an attack on family. This is one of your greatest and most hurtful lies.

This is only a small part of what is in the Samsha document linked above. No one is saying that the mental health system is anywhere close to okay. But neither is it what Murphy and the guys say it is. Whatever Samsha is it is not the demon Murphy says it is. And whatever it needs or we need the Murphy exorcism is not it.

Life can get better. And the lie that it cant might be a better focus of exorcism if exorcism is what is truly needed.

A day on the hill

March 17, 2015 by


From last year. Unfortunately I will not be there, but this is a day way past anyone person. It is a day for Tennessee. Last year they said we deserve their best. It is a good message for this day to. Celebrate victories. But never stop. Speak loudly and ask, no expect their best.

Larry Drain

Originally posted on Hopeworks Community:

Today over 400 people come to the Tennessee state legislature to talk about mental health. It is our “day on the hill.” I am so pleased to be one of the 400.

It is our day to be the story. It is our day to tell those who serve us what is important to us, to talk about how mental health issues impact not just our lives, but the lives of thousands of Tennesseans who couldnt be there. It is our day to show in the diversity of our experiences a common truth. Mental health matters because we matter.

It is our day to show the lie to the common prejudices about mental illness: that somehow we are deficient in human qualities or character, that less can be expected of us or that we expect less of others. It is our day to show legislators that hope can be a…

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On the faith of psychiatry

March 17, 2015 by

From the archives

Involuntary treatment is based on one article of faith: that the diagnosis of mental illness is reliable. It is function of what is really real and not the personality, training, philosophy or experience of the person doing the assessment. The assumption is that any competent professional would make the same diagnosis that someone else made. This is a critical point. Anything that questions the objectivity of the process challenges the legitimacy of the whole process.

If doctors tend to see what they are trained to see or what they are used to seeing then that is a real problem.  Psychiatric assessment of any kind is not just a medical thing, but a matter of personal preference or belief.   On a personal note I have watched different psychiatrists in a hospital or a private practice have very different assessments of the same people. In reading Gary Greenberg’s book “Book of Woe”  I have found much that relates to the subject of the reliability of psychiatric assessments.

One of the things the DSM tries hard to do is prove it measures what it says it measures.  Field tests are done to see if clinicians are presented with the same information about a case will make the same assessment.  In other words is the assessment a function of the symptoms displayed by the client or a function of the clinician making the assessment.  The results are measured by something called a kappa score.  A score of zero means that the assessments had nothing to do with the case but with the people making the assessments.  A score of one means that the assessments were purely a function of the case and not the people making the assessment i.e it was “objective.”  These scores are basic to credibility.  If your assessment is not a function of “your symptoms” then psychiatrists are not measuring what they say they are measuring.  It is worth noting that typically the results in the research settings are normally much higher than they are in real life clinical practice.

The DSM flunked.

Major depressive disorder and generalized anxiety disorder are two of the most straightforward and most used diagnoses.  They are meat and potatoes diagnoses.  The kappa score for major depression was .32.  The kappa score for gad was .20.  .40 indicates poor agreement.  So much for the scientific objectivity of psychiatric assessment.  It depends on who is doing the assessment. Period.

The objective assessment of emotional illness is a myth.  Some people may indeed be very good at it.  Some are obviously not.  And everyone seems to be different.  One persons truth is not another’s.

Given that does that affect  the reliability, the rationale, and the ethics of committing someone against their will.  I, for one, think it does.  On more than one occasion I have seen committal abused.  I have seen psychiatrists ready to “pull the trigger” at a moments notice.  I have seen others say, “Where is the beef?”  I have seen psychiatrists threaten people with committal because they were mad at them or felt like they were not shown proper respect.  I have seen people committed with the primary symptom of good insurance released when lack of benefits cured them.

Sometimes people may need to be protected against themselves.  I have friends who view committal as saving their lives at a time when they could not take care of themselves.  The potential for abuse though is real.  I know many people who can attest to that through their own experience. 

It starts by realizing that psychiatric assessment is something done by human beings and it only at our own risk that we assume that is a function of some objective psychiatric God.  It just isnt so.

Is there any good reason to believe psychiatrists are rational

March 17, 2015 by

The decision to put the control of one person under the control of another is based on the assumption that the person in control somehow knows better and that somehow justifies them making decisions for that other person.  It is far from an academic question.  Much of the current hullabaloo about mental health reform created by the Murphy Bill is fed by the belief that the biggest problem with the mental health system is that the authority of psychiatrists have been compromised.  Basically the answer Murphy proposes is to re-establish the control of psychiatric vision.  The problem according to Murphy is we are not medical enough.  He would have us become more medical.

The question is real simple. Is there any real evidence that psychiatrists are rational?  Are they rational or rationalizing?

My impression, based on my personal experience, is that psychiatric care is often more a function of the psychiatrist rather than psychiatry.  I remember reading of the failure of the new DSM to show either reliability or validity in the assessment of even their most basic diagnosis.  Different people saw the same thing chronically different.  And somehow that doesn’t seem very scientific or very rational.

Anyone who has been prescribed a psychotropic medication can tell you doctors tend to have medicines they love and an affinity for diagnoses that support their use.  Most of the psychiatrists I know still see the question of what bipolar is, who really has it and what works best with it as an ongoing debate and not a closed scientific fact.

Finding good reasons to do something and having good reasons to do something are not the same thing.  I have a friend taking abilify that went to her psychiatrist with complaints of akathesia.  He told her she was right but the medicine seemed to be controlling her symptoms and recommended increasing it.  Even the most irrational things can be rationalized.  She told him that at least she now knew which one of them were crazy and got up and left.

Medication is at best a guess and some psychiatrists are just not very good guessers.  And if becoming a better guesser is becoming a better psychiatrist does that mean their judgement should be given priority over yours or mine?

There are two kinds of reasoning.

“Can I believe this” is a search for justification.  Can I come up with a plausible reason for doing what my intuition, my experience, and my prejudice tells me to do that others will buy?  The search for rationalization is more about how what I am doing will look than it is about why I am doing what I am doing.  People who do this have a remarkable ability to ignore inconvenient facts.  Its all about the story they are selling.

The second kind of reasoning is “must I believe this.”  Is this where the facts and evidence lead? Sometimes it leads to saying “I don’t know” or “I was wrong.”  Neither of these seem to be very psychiatric notions in my experience.

Much of Murphy is about retrieving psychiatric turf.  Somehow to me it seems a step back

Perhaps all of us are at the bottom rationalizing creatures.  Looking good, looking like you are right seems always more important than being right.  Is there any proof that psychiatric judgement is of a higher value than yours or mine, a value high enough to justify them making decisions for you or me.  I don’t see it.  Is the mental health system really suffering from a defiency in psychiatric vision and power?

What do you think?


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