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[Willy]

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//Trigger Warning - This post contains information about disturbing mental health practices and atrocities that are taking place in Australia. Please do not read this post if you think it is likely to upset or trigger you.

SANE administration issues

I appear to have become somewhat unpopular with the SANE administration since initiating discussions on mental health reform and participating in the SANE organisation's National Standards audit. I am attempting to resolve these issues with the administration off line so I will refrain from any detailed discussion about them here other than to say that I understand, respect and fully support the need for the SANE organisation to conduct a safe, respectful community that protects the anonymity of its members. I also think it is important to protect members who for one reason or another don't wish to become involved in these sorts of issues. These are some of the issues that I am attempting to discuss with the management.

Declaration of War

Throughout this year I have become increasingly aware of what could well be described as a world wide mental health war. I am calling this a battle between the “Traditionalist” and "Progressive” schools of mental health.

Traditionalist View explained

The traditionalist view is based on the idea that mental illness is a physical disease caused by an imbalance of brain chemistry. To treat this disease it is necessary for a medical specialist to diagnose the type of mental illness and then treat it. Treatment is typically carried out using one or more types of psychiatric medications that are prescribed and monitored by a medical specialist such as a psychiatrist.

There are also other sorts of treatment less commonly used in Australia such as ECT (electro-convulsive therapy) and psychosurgery which involves cutting out a part of a persons brain . These latter practices are banned in many countries but are still being legally carried out in some states of Australia and can be done under an Involuntary Treatment Order. (Ref 1)
The pure traditionalist view does not recognise|

• The need for therapy or related life skills training
• That social factors such as freedom from discrimination and violence, friends family,       peer support and jobs, adequate income, housing etc effect mental health.

The main argument against the traditionalist view is that the chemical imbalance, brain disease theory of mental illness has never been proven to be valid. This misinformation has been known about for many years but the myth has persisted because the pharmaceutical companies have used it as a part of their media propaganda campaign to sell their products. Vast amounts of money have been spent promoting this view which has now become deeply entrenched in many peoples belief systems. (Ref 2, 3)

Progressive View explained

The progressive view has been driven by psychological research in universities around the world. This research is often described as evidence based because theories are tested and the results are usually subject to critical peer review before they are published. As a result there has been large developments in the psychological and sociological approach to mental health which includes the following

• Diagnosis of mental illness into a wide range of “diseases” has been found to be invalid and more or less meaningless. Diagnosis is also considered by some to be stigmatising.(Ref 4, 5)
• Psychiatric medication is recognised as being helpful for many people but often has unwanted side affects. There is little evidence that it corrects any underlying biological abnormality. It can also have significant negative long term affects. It works reasonably well at controlling symptoms only for about 20% of people who use it. (Ref 6)

In the Progressive model, mental health problem are considered to be the result of

• Life events and trauma
• Difficult Relationships
• Inequality, poverty, racism and discrimination etc

Solutions include

• Basic needs such as housing, money, jobs, good food
• Emotional support is considered very important
• Various types of therapy and life skills training

The United Nations Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment has called for a ban on forced psychiatric treatment including drugging, ECT (electro-convulsive therapy), psychosurgery, restraint and seclusion. (Ref 6, 7)

Australia has one of the worst records of any country in the world for involuntary treatment and confinement. Here are the numbers of community treatment orders for each state with Victoria topping the list. These tribunals, particularly in Victoria must be a virtual production line. These figures are from 2010/2011. There doesn’t appear to be anything more recently available which suggests that things may have got worse rather than better. Another point to keep in mind is that many people who are threatened with an involuntary treatment order accept voluntary treatment rather than go through the hassle of dealing with a tribunal so the real number of involuntary treatments are probably much greater than these figures indicate.

Vic 5521
NSW 3377
Qld 2822
SA 847
WA 972
NT 129
Tas 154

Total 13, 822

Community Treatment Orders Per Year for 2010/2011 (Ref 8 )

The main argument against the progressive view is that it does not provide the simple “just pop a pill” solution that many consumers would like. Another problem is the fragmentation of resources and information. There are many small groups working out of different universities around the world. A lot of worthwhile research goes unnoticed, except by other academics and a lot of this material is difficult to access and understand. Academia is no match for the sophisticated marketing machines of the multinational pharmaceutical companies.

Conference of the Clueless

I don’t think too many people disagree these days that the mental health system throughout Australia is a mess. In September this year I attended a lavish la-de-da mental health reform conference in Melbourne. From memory it cost about $600 a ticket but I was offered a freebie by one of the reform organisations that I am endeavouring to collaborate with. The Victorian Minister for Mental Health, the Hon Gabrielle Williams stood up on the podium and told us all in her best Pollyanna voice that everything would be wonderful from hereon in. At about the same time one of the members of this forum, who I believe resides in Victoria, was going through a horrendous and in my opinion, completely unjustifiable ordeal with yet another tribunal hearing for an Involuntary Treatment Order (ITO).

Everything is “wonderful” indeed. While all the grandiose inspiring speeches were going on inside the conference hall, out in the corridors there was much wailing and gnashing of teeth as the real stories were being told. There were a lot of people at this conference running around suggesting or demanding that the Victorian government pass new legislation and/or spend more money on new projects etc but not one person I spoke to really seemed to understand the reason behind all the problems. It is impossible to solve a problem if you don't first understand what the problem is.

Which side are people on?

At the very centre of this “war” are people like ourselves who have significant mental health issues that often include psychotic tendencies. Close by are the friends and families who often standby helplessly watching the suffering we endure and are at a loss to know what to do about it. The magnitude of the problem only starts to become apparent with the knowledge that in Australia, about 20% or 1 in 5 people will experience mental health problems of one sort or another in any one year. This number rises steeply if you look at the number of people who experience mental health problems throughout their life time. These figures seem to be fairly similar to other developed countries.

Public Ignorance

In my opinion there is a massive amount of public ignorance surrounding the entire field of mental health. At the same time there is an enormous amount of highly credible research that has taken place over the last thirty years or so that many, perhaps most are quite oblivious to.

Are the Traditionalist Ahead ?

A 2007 survey in the US suggests that more than 80% of the population believe that mental illness was a physical disease caused by an imbalance of brain chemistry. (Ref 2)

This is an old survey and that number has probably decreased somewhat but it still suggests that the traditionalist school of mental health remains significantly predominant. This explains why government led reforms have stalled and will continue to do so until public perceptions change significantly. .

No Political Will

Australia is a democratic society and that requires a majority of people to be in agreement to get things changed. To be more pragmatic about it, a politician's highest priority is usually to win votes so as to keep their job. While the government know they should act for ethical reasons, to do so at the moment would be likely to cost votes, hence no political will.

Danger To Society

Out of fear or ignorance, large numbers of people are opposed to changing things that would in their minds allow vast numbers of crazy people to run amok in the community. There is no evidence to support this fear. All the research seems to suggest that people who suffer from psychosis, i.e act in a crazy manner, are no more likely to harm others than anyone else in the community. Psychotic people are very much more likely to be subjected to violence and abuse including violence from police and other authorities. (Ref 6)

Revealing The Ugly Truth

I believe very few of the general population know about what is actually going on with mental health services in Australia particularly in regard to things like involuntary treatment and confinement. I think most people would be horrified to find out the truth. I see it as our job to tell them and raise awareness to bring about change.

continued in part 2...
Link to part 2 

[Historylover]

Hello @Willy. It's obvious you have kept busy. I don't know how to reply, to be honest. I'll just attach my comment to a Critical Psychiatry Blogspot post from earlier this year. Sometimes I just get so frustrated with all the goings on in the 'profession' and psychiatrist's pretensions of trying to do something about it; but an entire career can pass with no change for the better—only for the worse. One would think we lived in the Dark Ages. I had to comment on the ignorance re depression on the psychiatric post as follows:

<https://criticalpsychiatry.blogspot.com/2022/04/blaming-chemical-imbalance-in-brain-for.html>

 Relational psychiatry: Blaming chemical imbalance in the brain for depression does not make sense (...

I hope the URL opens. So many points of view, and very few within psychiatry are correct. Cheers.

[Appleblossom]

@Willy Good to see you.

@Historylover Hey

I tend to find your posts informative and interesting, and for the most part I agree.

The numbers of ITOs and CTOs are significant.

I am careful with language as it can be slippery and have unpredictable consequences when dealing with complex issues, but it also the best tool we have ... 

I went to an CTO meeting this week, and we gained an acceptable result (from 52 to 16 weeks). However when the psychiatrist member of the tribunal advanced the ... its like diabetes argument I switched off personally and she lost points thinking I was stupid and had not done science or my own research.  There was no point arguing as time was limited and I advanced my approach as 'limited responsible med taking with respect to ongoing awareness of internal and external conditions'.  I was there as carer/mum. The report by "treating team" was littered with errors including telling us to go to the wrong address.  A bad joke actually.  But I am no longer surprised as I no longer hold the MH system as knowledgeable or effective in terms of mental health of my family and society generally.

I am wary of using language like "declaration of war" though I can well understand some people will feel like that.  (just personal choice and history).

I also was amused that you called the chemical imbalance view the traditional view, as opposed to a progressive view, as I do not, think that way.  I try to be careful about creating binaries and polarising arguments, but not quibbling as I get what you are trying to say.  I am careful about equating psychosis with being crazy etc etc.  Words evolved to be different to numbers and they each have a place in understanding.

I see it more as changing fashions ... and see the moral deficiency and old religious view as more traditional, with the rise of the sciences and view of the brain as a chemical sponge just one part of an evolving knowledge.  Understanding of nervous system and electrical aspect of brain function is newer ... eg vagus nerve etc etc. There has developed a tendency to place "science" on a pedestal like god... so that says a lot about humans their societies. lol.. Cos I did enuff science and hung around with enuff science types, I knew it was not god.  I still love it - science ... Wanted to study History and Philosophy of Science at uni but timetabling never allowed it, ha ha. Too busy with work and kids. So now in my old age in the internet age, I can research to my heart's content.

So happy to be involved in push back. Well not really happy ... but you probably do not want more essays from me. 

I see the institutional and organisational problems you mention as partly due to funding and partly political forces.... as in trying to capture a bigger audience to justify themselves and wages etc.

Pretty turned off by Pollyanna superficial reassurance assertions generally.  It can be offensive when things are not great.

[Shaz51]

Hello and hugs @Willy , @Historylover , @Appleblossom ❤

[chibam]

A lot to digest here @Willy . There are multiple things I wanted to address, but I probably won't get time to do it all tonight.

Traditionalist vs. Progressive

Reading your section on the traditional and progressive views on mental health, I got a strong sense of a black-and-white undertone. Which view is the right one? Which one is the wrong one?

My own suspicion has long been that there is truth in both views. There are indeed a handful of people who are accurately described by the traditional view. People who have good lives but, for lack of a better phrase, have a malfunctioning brain. I've heard enough testimony from such sufferers to believe that these situations do certainly occur.

The problem is that there is a massive degree of over-diagnosis of such conditions; and people who simply need life help such as set-ups with new social/romantic contacts, relocation, new employment, ect. are instead being subjected to pointless medication, "talk therapy" and even worse abuses.

That crisis of over-diagnosis, and the lack of a proper system to address the problems that the patients actually suffer, is the problem we need to focus on.

Ultimately, I believe that making a hard-line denial that there is any legitimacy to the traditional view will undermine our cause. Because I don't think it will take much effort for the supporters of traditional views to demonstrate that there are indeed cases where it certainly applies.

Progressive Solutions (or lack thereof)

I've become very disillusioned with the endless vaguery in statements being made supposedly in the interest of creating remedies as per the "progressive" view. In particular, a lot of the proposed remedies seem to be only available to people who have some sort of underlying mental condition. People who don't have such a condition seemingly aren't on the agenda to receive any help. If your unemployed because you've got depression, you'll be given a job; if your depressed because your unemployed, there's no help on the horizon for you.

And although there are vague mentions of such help being on the agenda, there is no clear information being laid out as to exactly where a person can go to get this sort of assistance. Is there going to be a list of names and (business) addresses put out at some point, for the therapists who are going to dispense these sorts of real-life help to people who need it? How's the average punter going to know the differance between a therapist who will actually endeavor to fix their crappy life, and a therapist who only wants to endlessly talk about their crappy life?

Despite acknowledgement that, very often it's the crappy state of peoples' lives that make them miserable, I've seen pretty much no evidance that the powers that be have any concrete plans to fix these problems. Which is astounding, as the solutions are (in many cases) immensely straightforward; and could be realized for minimal cost.

My point being that I have qualms about backing the "progressive view" camp, as they seem to say "the right things" only in the vaguest possible terms, and seem to have no solid intentions of actually promoting the straightforward solutions to the problems.

Danger To Society

I think it's important to recognize that when we talk about people not wanting "vast numbers of crazy people to run amok in the community", the issue is far more nuanced then the simple fear that Hannibal Lecter down the street may pounce on me one day and eat my face off.

We are living in a time when half the world are aghast that they have "insane Democrat-types" running around their communities, and the other half are aghast that they have "evil psychopathic Republican-types" running around their communities. The last thing most people want is yet another alien, incomprehensible mindset running around, further distorting the already tenuous rationality of the world they have to endure every single day.

This is an immensely pressing issue for many people. They agonize over it just as much as we agonized over the threat of jihadis at the start of the millenium; and they agonize over it far more, I believe, then they agonize of the scant risk of being the victim of some random act of violence.

Proving that the "vast numbers of crazy people" pose no threat to the community will have to go far beyond showing that they aren't carrying knives in their pockets. Your gonna have to prove that these people won't destroy the framework of society with their votes, and the numerous other ways they shape the look and feel of the landscape. Until people feel they can trust the "crazy people" in that regard, the fear and hostility will never go away.

[Historylover]

Back at you, @Shaz51. Hoping all is well with you. ❤️ 

[chibam]

@Willy 

One other thing I wanted to note was the implications in your post that the "traditionalist" view is still held by an overwhelming majority of the population. You do, however, also note that the evidance you've based this assumption on is pretty dated (2007).

I, for one, have been noticing massive shifts against the traditionalist premise that "mental illness" all comes down to broken brains, and increasing acknowledgement that the despair and suicidalness within our society largely comes down to the quality of peoples' lives, and, on a more meta level, the failings of our society. These changes in attitudes coincide with a recent massive public backlash against big pharma, widely believed to be the main villains behind our modern excessive usage of the traditional mental health doctrine.

I stumbled upon a video clip only the other day, where a certain high profile therapist (who I often don't agree with, but who nonetheless agreed with on this occasion) went on at length to clarify that a significant amount of depressed people are actually depressed because they have terrible lives; not because there's something broken in their brains. Not the first time I've heard that admission from a therapist, but it was reassuring to hear again, nonetheless; to know that there is increasing awareness that suffering is very often a life problem, not a brain problem.

Unfortunately, the video went in a weird wishy-washy direction after that, in which said therapist somehow managed to circle back to talking about these real-life problems as if they were brain problems. So, instead of talking about real-life solutions, he starts talking at length about how to fix these peoples' broken brains. Old habits reasserting themselves after taking a few steps in the new direction, perhaps.

This might be something we need to be mindful of; superficial acknowledgements of the "progressive" stance, by people whose deeper thinking is still entangled in traditional views. Perhaps the question of "which camp is ahead?" is far more layered then it seems at first glance.

This may also go some ways towards explaining my previous concern about the absence of any concrete plans/commitments to deliver real-life help to people who need it. Because so many of the people running the show are still somewhat trapped in the mindset that the problems are in the sufferers' brains.

[wellwellwellnez]

Great convo' @chibam @Historylover @Shaz51 @Appleblossom 

I keep thinking about this part @Willy 

"Are the Traditionalist Ahead ?

A 2007 survey in the US suggests that more than 80% of the population believe that mental illness was a physical disease caused by an imbalance of brain chemistry. (Ref 2)"

It seems like part of that 80% is people being too pill-happy. Another part would read that question and see it as a way of blaming the condition and not the individual. Which is kind of nice, or at least it's something.

The next leap of understanding just requires opening one's scope of what affects "chemical imbalance" i.e; the chemical imbalance caused by social toxicity and (perhaps more importantly) the restorative powers of social nurturing.

I think that's roughly how most people get past the "medical model" and into better understandings. I'm personally still into "psycho-social" thinking. I think it has potential if we progress using it as a two way mirror.