Imagining Something New
They did it. They succeeded in helping me see myself as a bipolar defective again instead of the talented, strong, intelligent and beautiful human being that I really am.
In the 1997 movie Good Will Hunting, starring Robin Williams and Matt Damon, psychologist Sean Macguire tries an alternative approach to reach his patient, who had suffered early trauma in life through domestic violence. “It’s not your fault,” Sean repeats again and again as he steadily moves towards him. Will Hunting finally breaks down and collapses into the safe arms of his therapist. The compassionate approach. I had seen that movie years after the diagnosis and I thought to myself, “Does anybody know that this is not the way it works?”
It’s All In the Name
On February 16, 2019, I attended a seminar at Wesleyan University called: “Naming Madness: An Interdisciplinary Symposium.” I wanted to meet Robert Whitaker. He wrote the book, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Perseus Publishing, 2002), in which he exposes the history of corruption and abuse in the field of psychiatry. President of the Mad in America Foundation, Whitaker is on the front lines in the frontier for change in the field and is making steady headway fighting for social justice. But he’s up against a monster of power that has no interest anytime soon in relinquishing its rule. Robert identifies himself as a critic of psychiatry. I introduced myself to him as an anti-psychiatry radical and told him a little of my story as he listened with open ears and compassionate eyes. He had heard this story before, thus his campaign against the field.
Presented by the Science in Society Program, The Allbritton Center for the Study of Public Life, and the Department of Psychology and Department of Philosophy, the symposium’s aim was to challenge conventional scientific categorizations on what is normal and abnormal through imagining alternative models for understanding and labeling forms of “madness.” The Resource Center, an on-campus group dedicated to social and political activism, organized the event. In its mission statement they commit to “developing a critical consciousness that involves decoding the social lies that naturalize the status quo, while searching for alternative interpretations of one’s situation.”
Among the panelists of the first session was Alisha Ali PhD, Associate Professor in the Department of Applied Psychology at New York University. Her research examines community-based and arts-based treatments for the mental health effects of trauma in a range of populations, and her work with military veterans in The DE-CRUIT Program is breaking boundaries. Derived from a military veteran’s perspective, the program was founded by internationally acclaimed actor Stephan Wolfert, who was a U.S. Army Medic and Infantry Officer for seven years.
The theater-based treatment program uses Shakespeare’s text to aid in the transition from military service back into life as a civilian. Military veterans work through their personal traumas by constructing monologues in the tragic style of Shakespearean plays and then performing them for an audience.
Alisha explained that the program developed and delivered by veterans and for veterans is therapeutic because it helps them connect with their community through shared experience rather than a shared illness. Instead of diagnosing a pathological “disease” within an individual, the program reminds the vets that they aren’t crazy, but that war is crazy. Alisha argues that concentrating on deficits does not help the patient, but rather negates what makes the entire person. By approaching distress without medicalizing or consumerizing human suffering, she found the treatment to be remarkably more effective than the standard psychiatric treatment of issuing labels.
To this a seemingly intelligent man sitting in the second row raised his hand and said, “Psychiatry doesn’t call these conditions ‘diseases’ but rather ‘disorders.’” I thought to myself, beyond just a question of semantics, this naïve soul is obviously unaware of the foundation upon which psychiatry stands. His statement is simply not true. According to psychiatry, these “disorders” are pathological “diseases” that stem from our genetics. Psychiatry’s biomedical model asserts that we are born with defective biology. It’s good that he’s here at this seminar, I thought. At least he’s open to learning something.
He continued in a casual, light-hearted tone, “Psychiatrists use the DSM to label within context, taking all other factors relating to the symptoms into consideration. Only then is the diagnosis made through careful scientific determination. The label applied is only given within context.”
Who is this guy? He’s clearly misinformed. Psychiatric labels have nothing to do with context. In fact, with the release of the DSM-III in 1980, the American Psychiatric Association eliminated “context” as a necessary factor in determining psychiatric disorders, especially those involving psychosis. Rather than analyzing the meaning of symbols inside psychosis, doctors instead base their labels for life on observations of behavior alone often having no context for a person’s outward actions.
The DSM, or The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, is the standard diagnostic reference for the classification and treatment of psychiatric conditions. First-hand stories that provide real-life context as to why people exhibit strange behavior are disregarded when a psychiatric diagnosis is being made from the DSM. When I found myself in a psychiatric institution after coming home from a life-threatening experience in India at the young age of 22, as a wounded soul with a real story as to how I got there, no one cared to listen. It wasn’t until 10 years after the prescribed label when I found a psychiatrist willing to open his ears to it. Although, I needed to pay him $350 per month to be looked at and studied for nearly a year until the subject of India even entered the conversation. If my trauma in India was discussed on day one, under a normal set of medical ethics, I never would have received a mental illness diagnosis. But according to their scientific “experts,” my emotional breakdown upon entering that hospital had nothing to do with my trauma in India—even though it occurred only four days prior.
Without India being considered at all within fair context to the situation at hand, I was thrown into a box with the label they assign to the artistic personality type—the sensitive dreamers of our world, the bipolar people who appear abnormal to much of society in the idiosyncratic and unusual ways we interact with and interpret our world.
The descriptive categories in the DSM pin mental illness labels to people who don’t appear “normal.” The classification of “bipolar disorder” includes descriptive symptoms like irritability, moodiness, and extreme bursts of energy—all natural and normal predispositions of the creative artist. But to psychiatrists, they are abnormal, and therefore, we are mentally ill.
I remember when right after I received the label back in 1994, the year the DSM-IV was published, I told my psychiatrist instead of taking anti-psychotics, I might benefit more from a good dose of family therapy. With heat and condescension, she replied, “You are the one with the problem! The sooner you realize that, the sooner you’ll feel better!”
“Well India is most certainly what got me in here to begin with,” I responded.
“No,” she said firmly. “You were ill before you went to India.”
I realized early on that they thought it was something inherent within me that caused the trauma. I knew otherwise and from that point forward I was highly suspicious of the ethics and validity of this “scientific” labeling program. Because after the label, they tried to convince me for the rest of my life that there was something wrong with the mechanics of my brain.
After Alisha delivered her research, I felt lighter, slightly encouraged that there are talented professionals in the field of mental health questioning the DSM’s legitimacy and working on alternative approaches to dealing with trauma. But as the second session of the seminar began, and Michael B. First MD from Columbia University was announced as the first panelist, I was immediately disheartened when the naïve idiot from the second row in the audience stood up to take the podium.
Now completely disempowered, my healthy ego shattered in seconds, I humbly sat there as the ill one he was talking about. I was the defective abnormal bipolar to be judged once again, and publicly so, by the more evolved normal. I was used to this. Psychiatrists had been speaking about my kind with disrespect and disregard in my presence for decades. I looked around the seminar room. Most attendees were students in psychology eager to learn and be led by the experts without knowing any better. As a celebrated, respected psychiatrist in the field, why had he lied to the members of that audience? Because young minds are easily molded. Michael prattled on about the question of diagnostic kinds, with the cheerful attitude that he and his league of professionals are nobly contributing to saving the world from us nutjobs.
A member of the DSM-5 Taskforce and editor of the DSM-IV, Michael claimed the DSM is the most effective diagnostic tool out there that addresses “the disorder” over a course of time—rather than just a fixed point in time. As he supported his position with “this is what the research shows over the last 35 years,” I scoffed. I have my personal case history on record with all the facts and details outlined in my book as one of the psychiatrically labeled mental defectives under their codes and theories for the last 25 years. Michael, along with every other psychiatrist, believes in labels for life. This group of “professional doctors” is convincing the masses they need to rely on an institution to tell them what to think of themselves and the rest of the waking world forever amen.
Psychiatry only treats “symptoms” without regard to the damage it does, which violates the first and foremost rule of medical ethics: Do no harm. These treatments are aggressive, forced, and ultimately annihilate the chance for the patient to achieve any true personal healing on her own. During most of my twenties, I was treated with debilitating anti-psychotics with the promise from psychiatrists that it was in my best interest so that my “symptoms” could be controlled. With the “side effects” of the medication, I lost all my ability to paint, as the psychiatrists assured me that: “A lot of artists with bipolar disorder complain that the meds affect their creativity. You’ll get used to it. But you must take the meds because you cannot live without them.” In truth, what the artistic personality type cannot live without is access to their naturally encoded DNA that enables them to express their highest potential through their creative impulses. Taking away that joy in the name of “treatment” is psychologically and physically abusive, and by no means therapeutic.
The Biomedical Model
One of the main criticisms of DSM-5 were the changes made to the definitions of mental disorders placing more emphasis on biological theory than on socio-environmental factors. The over-diagnosed attention deficit hyperactivity disorder (ADHD) label, for instance, is now a “neurodevelopmental disorder,” suggesting a definitive biological basis. Even after the “decade of the brain” not one biological marker can reliably substantiate a DSM diagnostic category, but the institution purports this as proven science. Under this imposed belief by psychiatric science that our human thoughts and feelings are physically located in the neuro-circuitry of the brain, I was taught as a young adult to fear my own mind.
The formation of the DSM was influenced by German psychiatrist Emil Kraepelin’s work (1856-1926), who is credited as the founder of modern scientific psychiatry, psychopharmacology (the study of effects of psychiatric drugs on the nervous system), and psychiatric genetics. Kraepelin’s biomedical model alleged the origin of mental illness to be biological and genetic malfunction. His work leaned toward a more generalized approach to diagnosing symptoms in psychosis. Rather than looking at the contents of individual experiences, Kraepelin was interested in finding patterns in psychotic behavior that could be used for a therapy plan for two main groups: schizophrenia and manic depression (the former terminology for bipolar disorder). By disregarding psychosocial factors through the generalization of behavioral symptomatic markers, psychiatry reduces its patients to nothing more than Pavlov’s dog.
Professor Emeritus of Social Welfare at UCLA, Stuart Kirk, who has been tracking DSM for decades, states, “The whole disease model that underlies the DSM has been an utter scientific failure. There’s not a single biological marker for any of the 300-plus disorders. What we do instead is descriptive.” (Jayson, Sharon. “Books Blast New Version of Psychiatry’s Bible, the DSM.” USA Today. 12 May 2013.)
An expert in his field, Michael admitted that psychiatry’s diagnostic criteria is only descriptive as he assured the audience, “We haven’t found any biomarkers yet, but they are out there.” With no evidence, how can he be so sure? And how long are we going to search for something we can’t find? Is that really science? Going into the research saying, I know the truth, let me find evidence to prove it; and then attempt to do such a thing for nearly a century? No, it is not. Proper scientific inquiry involves making a new hypothesis after no supported evidence through observation is found. But psychiatrists aren’t open to anything else because it threatens their positions of power.
Michael also openly admitted with no shame that the DSM is mainly used for communication among psychiatrists offering them a shared language—or code language—when referring to those with disorders. Additionally, they are used for billing purposes for the insurance companies to cover prescribed treatments—which always includes psychiatric drugs supplied by Big Pharma. My own label was changed by one of my psychiatrists in 2007, when he assured me that my treatment would be cheaper if I had a more severe label attached to my name. He increased it from mild bipolar disorder to moderate, which substantiated the institution issuing me further unnecessary and aggressive hospitalizations later on down the line due to my worsening condition. This is corrupt by ever measure. Insurance fraud is a bad thing, right? Or is it acceptable by today’s standards because it only affects the throwaways of our society? The labeled mentally ill.
Interestingly, after his whole spiel, Michael acknowledged that he is “worried that the DSM is being misused.”
I was torn as to whether I should reveal myself as one of the abnormal rejects he spoke about and almost did so with half raising my hand, but the Q&A ran out of time. The truth is I was afraid to speak, because in the presence of psychiatrists, if I should share my point of view with too much of an attitude problem, a bipolar symptom they call “irritability,” they might call the authorities right there on the spot to usher me away to the nearest loony bin again. These lifelong labels are taking away our voices for good, as they have succeeded in quieting the dissidents of the status quo in our modern age. Where have they all gone since the 1960s? They are laced on psychiatric meds. And there is no hope for our kids’ futures either, who through initiatives in mental health reform in the 1990s can now receive a psychiatric label as young as three. Unsuspecting parents who wish to get their children additional academic support from the school system acquiesce to labeling their kids in the interest of short-term gain, which will sentence them to a lifelong burden of pain and ostracization.
The Loss of a Loved One
Psychiatrist James Phillips from Yale University was also on the panel addressing the recent elimination of the “bereavement exclusion” in the DSM-V. Under the DSM-IV, a normal person dealing with grief after the loss of a loved one could be excluded from receiving a diagnosis of major depressive disorder (MDD) even if they exhibited similar traits to those with MDD such as profound impaired concentration, significant weight loss, and severe insomnia.
The removal of the “bereavement exclusion” was arguably the most controversial change from DSM-IV to DSM-5. Critics like James argue that its removal “medicalizes” ordinary grief and will encourage over-diagnosing. But supporters of the DSM-5’s decision, like Michael who was asked to join James in a friendly debate on the topic, reason that there is no clinical or scientific basis for “excluding” patients from a diagnosis of major depression simply because the condition occurs shortly after the death of a loved one. Though bereavement-related grief and major depression share some features, he said, they are distinct and distinguishable conditions, which can be determined by a psychiatrist through careful critical judgement.
In 2002, a friend of mine whom I worked with at Manhattanville College Library, had lost her daughter, Annelisa, to a tragic airplane crash while coming home from a scientific mission in Central Africa. Having been only 35, her mother, along with everyone else who knew her, was filled with remorse. Her daughter was a field veterinarian for the Wildlife Conservation Society, and her research established that gorillas can die of the Ebola virus, which directly contributed to the preservation of Africa’s primates. She was well-known and revered at the Bronx Zoo, and the ceremony they held for her funeral invoked tears in every one of us. Sadness stayed with us all for many weeks thereafter, as we struggled with the senseless way she left our world. But for her own mother the pain was unbearable. So she decided to visit a psychiatrist to get some meds to calm her angst.
In the petri dish she sat for months as the psychiatrist told her he “discovered” she might have MDD, which would explain why she couldn’t yet cope with the loss. Under the bereavement exclusion guidelines in DSM-IV, she managed to avoid getting a lifelong label and mandatory, ongoing psychiatric treatment, and was given the chance instead to work through her grief on her own and in her own timeframe. Under the new criteria for DSM-5, however, in having met the appropriate “symptom-duration” period within only the first few weeks after bereavement, if she still showed signs of depression, she would no longer be excluded from the label. As the DSM-5 now medicalizes mourning, if my Italian ancestors were alive today, every one of them would be heavily medicated and thrown into insane asylums as it is a custom in Italy for a widow to wear black for a year after her husband’s death.
It is not acceptable that psychiatrists have made normal grief a mental disorder. Working through emotions of loss is a personal matter, and each person deals with bereavement differently; judging how long it should take is entirely removing compassion and human respect from the equation.
My heart thumping and angry blood pumping through my veins, I went into the hall to grab a cup of coffee and found Robert Whitaker pouring his own.
“How can you stand it?” I asked him.
He shook his head. “They know there’s a problem with the DSM with its validity being so vague. They are still dividing people into normal and abnormal. Where’s the human approach? We are all different. What does it mean to be human? That’s the narrative that I would like to see.”
Only One Alternative: Our Freedom
Sense and reason returned to the seminar room when Rebecca Miller PhD, Assistant Professor of Psychiatry and Director of Peer Support & Family Initiatives from Yale University, reminded the audience about alternative choices outside of the DSM. In 1994 Rebecca was hospitalized, and thereafter, she chose to work in the mental health profession focusing on community mental health services, community psychiatry, psychotherapy, mood disorders, and psychotic disorders. She shared the research and success of her work in peer-to-peer counseling among persons with severe mental illnesses, which treats the source of the problem with compassion. After giving a raw, honest account of her dissatisfaction with where the field has gone, at the end of her presentation she voiced, somewhat meekly, that she does have hope that there are signs of progress.
The final Q&A was open to the full panel of speakers, which Michael First managed to avoid by sneaking out beforehand. Heading the show was The Resource Center’s flamboyant Demetrius Colvin, who made the statement, “You can’t just be against something. You must also be for something.”
Regarding peer-to-peer counseling, James Phillips acknowledged that he did not like the idea of community-directed therapy, calling it too symmetrical, claiming that “asymmetry” was needed between a psychiatrist and a patient to find the best course for proper treatment. Or the expert vs. the subspecies, who don’t deserve supportive compassion from their peers. Despite all the evidence presented that day by his colleagues, it’s simply not enough, he said. Based on psychiatry’s main biomedical model drugs are the only treatment for mental illnesses, which only a professional psychiatrist can prescribe. The patient/doctor relationship, in which the expert in normalcy reacts to “abnormal” behaviors without context, is a permanent sentence to unfair, harmful, and often unnecessary treatment. Since our biology is lifelong, the relationship of asymmetry is maintained until the day you die.
James also admitted that psychiatrists cannot even take two hours to diagnose a patient with a lifetime illness: “We often have but two minutes.” These labels are determined by value judgments and subjective interpretation. They are given quickly, are lifelong, and are wrapped up with the insurance companies.
Despite the excellent research conducted by these mental health professionals in finding alternative approaches to dealing with human struggles with emotions, the truth is that there are millions of people crying out to be heard, with very few listening to the subspecies, the defective, the unevolved. No other “medical” institution has an “anti” associated with it, an active movement trying to break it down and replace it, but cannot, because the “experts” need to remain in their positions of authority.
Demetrius posed the final question of the afternoon: “With all that we face, how are we making ourselves complicit to the current situation?” Other psychiatrists on the panel sadly confessed that although they don’t like what’s going on and are trying to fight the wrongs of the field, they are complicit by the fact that they are still in the profession.
As one of the labeled mentally ill in the audience I thought: How do we make ourselves complicit? We have no choice. In psychiatric medicine, patients have no autonomy to refuse treatment. There is only forced compliance, institutionalization, or court order.
Afterwards I caught up with Rebecca Miller and told her, “Hey I was first hospitalized the same year you were in 1994! Whoop-whoop!” She and some of her colleagues smoking outside laughed and cheered me on.
One of the organizers in our circle confessed she was shocked that Michael said yes to her invite to come and speak. The others agreed with amusement. “I mean, doesn’t he know what we’re about?”
I told Rebecca, “I know that you have seen signs that things may be getting better as critics are growing. But in New York, things have gotten much worse over the last two decades. Our freedoms have been taken away.”
She nodded her head. “Right. With Kendra’s Law. But no one shares the whole story. Andrew Goldstein was seeking help, and the system let him down.”
“But now this law is locking up people like me,” I said.
She took a long drag of her cigarette and responded, “Uh-huh.”
Michael’s concern that the DSM labels are being misused is fully substantiated by the laws in the books in New York State. The ugly truth is, these coded labels have taken away our freedoms as American citizens—for good. The field has now moved into compulsory, court-ordered, forced psychiatric medication treatment by permanent state legislation.
In 1999, New York State signed off on Kendra’s Law, which was named in memory of Kendra Webdale, a young woman of 32 who died in January 1999 after being pushed in front of an oncoming subway N train in New York City by Andrew Goldstein, a schizophrenic man off his meds with a history of hospitalizations. It created a statutory framework for court-ordered Assisted Outpatient Treatment (AOT), which established mechanisms for identifying individuals who, in view of their treatment history, were likely to have difficulty living safely in the community without close monitoring and mandatory participation in treatment.
To ensure safety to the larger community, Kendra’s Law enables the police to show up at someone’s doorstep and escort the patient to the clinic for their anti-psychotic injection if they have not kept their medication appointments. It also provides grounds for forced hospitalization against a person’s will based on their diagnosis alone. Reinstatement of Kendra’s Law went into effect in June 2017 with no opponents, and on March 26, 2018 the NY State Senate passed legislation that strengthened Kendra’s Law and made its provisions permanent.
The Wrongs Are Clear
After the symposium, I discovered that Michael had written a book with psychiatrist Allen Frances a few years after the DSM-IV was published titled: Your Mental Health: A Layman’s Guide to the Psychiatrist’s Bible (Simon and Schuster, 1998). Interestingly, after being the Chair of the DSM-IV Taskforce and witnessing up close the corruption that had blossomed in his field, Allen Frances later entirely changed his position on the DSM in his book, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (Harper Collins, 2013). Published the same year as the DSM-5, Frances affirms that psychiatric diagnosis has become too important in clinical decisions having a huge impact on the way lives are lived, how mental health dollars are spent, within the school system, and in the courtroom. Allen Frances chose to expose the wrongs of psychiatry. Michael chose the path to more power. Either you are fighting the problem, or you are part of the problem.
Psychiatry’s meddling in the sanctity of people’s private thoughts and feelings is preventing social growth in our ill society. Extreme emotions alert us to what is important to us and are often driving forces within us to inspire change in our world. Challenges in life’s ups and downs, with all their stresses, disappointments, and sorrows, are part of living as a normal human being; and those who struggle with such natural human experiences should not be treated as walking psychiatric diseases.
With labeling being blurred, arbitrary and value-driven, people’s entire lives are being determined for them. Once diagnosed with a label, that’s it. It can worsen on file but not be let go—forever. Until my last living breath I will have “bipolar disorder” because the descriptive features of my artistic personality type reside in my biology, my genetics. They have been watching me for over two decades grow ever further into a happy and healthy individual, but by their standards, and on their records, I am getting more and more mentally ill with each passing day. The person I am today is not anything like the person I was 25 years ago, nor will be even 5 years from now, but getting a lifelong label denies that reality. The system is set up to hold people like me back from reaching our highest potential and becoming our best selves. What’s normal for me, is most definitely not normal for most people.
It’s great that expert psychiatrists like Michael B. First have managed to profit from his field’s aggressive takeover of the rights and freedoms of American citizens to do as they so choose with their own lives. It must be nice being a lifelong normal. Some of us, however, are not so lucky. For the abnormal artist lost in the world of dreams, lifelong is a much longer sentence to bear.