Thursday, February 26, 2009

Antipsychiatry: Dumb and Dumber

A few weeks ago, I came across a comment from an antipsychiatry blog referring to Kay Jamison as "lithium-addled." Yesterday, I stumbled on a blog post from someone named Stan, entitled, Kay Jamison, The Unquiet Fraud.

What gives?

First Stan comments on Vincent Van Gogh:

"If he lived today he would be locked away painting blank canvasses to no one ... blinded by antipsychotics ... "

Actually, Stan, for all we know, he might have picked up an Oscar the other night and thanked Pfizer for making it possible. What we do know is that Van Gogh aimed a pistol at his chest and pulled the trigger. He was 37.

But Stan contends, "it was never a life in vain."

Let's defer to Van Gogh, himself, on this: "What am I in the eyes of most people - a nonentity, an eccentric, or an unpleasant person - somebody who has no position in society and will never have; in short, the lowest of the low."

Who knows what choices Van Gogh would make today? Maybe he would choose not to lead a tortured life. Maybe he would choose to stay on meds. Maybe he would choose not to paint. That's the point, he could choose. He would have choices.

I really don't want to pick on Stan, and I would really rather be writing about other things, but this sort of thing is all too typical of the commentary on the blogosphere. The only reason I found this piece was because it came up near the top under a Google Blog search that day.

This is the new democracy of web 2.0. Anyone who takes five minutes to set up a Blogger account can get the same attention as Kay Jamison.

Speaking of Kay Jamison: In the same blog post, Stan takes Dr Jamison to task for ascribing Van Gogh's "precious madness" to the false label of bipolar. Not only that:

"Kay Jamison has been running around for many years publishing one book after another telling us all how wonderful her drugs are in controlling her 'Bipolar Label.'"

Hmm, excuse me if I'm wrong, but ...

Off her lithium, Dr Jamison attempted suicide. On her lithium, she is a professor at Johns Hopkins, co-author of the definitive text on bipolar, best-selling author, recipient of a McArthur genius grant and numerous other awards, plus was in a successful marriage (cut short by the death of her husband).

In short, Dr Jamison exercised a choice that was, sadly, unavailable to Van Gogh.


From mcmanweb:

Vincent and Me

There was that little bit of sky pressing down on the fields, as if of a heavier substance than earth, and there were the fields trying to crowd the sky out of the canvas, as if vaster than the heavens. And there were the crows, hedging their bets, represented by stark black flicks. ...

Madly Creative

Says Dr Jamison, in her introduction:

"The fiery aspects of thought and feeling that initially compel the artistic voyage - fierce energy, high mood, and quick intelligence, a sense of the visionary and the grand, a restless and feverish temperament - commonly carry with them the capacity for vastly darker moods, grimmer energies, and, occasionally, bouts of 'madness.'"


Cristina Romero-Sierra said...

Hi John. Another interesting piece. I'm happy to see that the glitch is fixed and we can now post comments.

It's upsetting that whether a person is on meds or off meds, they are often criticized. Damned if you do, damned if you don't.


I was wondering if you could consider that we now live in a time because of the meds available that we have lots of different groups of psychiatric patients:

-Off meds and sicker than on meds
-Off meds and better than on meds
-On meds and sicker than off meds due to side effects than off meds
-On meds and just as sick as off meds, due to side effect trade-off
-On meds and just as well as off meds, due to side effect trade-off
-On meds and better than off meds

A person's body and mind changes, and our response to meds change, etc., so any person can group hop. :)

What do you think?

Therese Borchard said...

This is an excellent post, John. I have the same frustrations. I heard Jamison speak a year ago on creativity and I was so empowered by her statement that drugs are our allies, not our enemies. You are the Peter Kramer of the bipolar world. Go get em! t

John McManamy said...

Many thanks, Therese. It's not an easy job living up to my reputation as McPimp*, Seroquel Sycophant*, reprehensible*, and on and on and on. But I'll try. :)

* Actual names I've been called by antipsychiatrists. Plus others way too numerous to mention.

(Click Therese's link to her BeyondBlue blog, which I cannot highly recommend enough.)

John McManamy said...

Hi, Christina. Excellent breakdown. And here is where I would love to work with "smart" antipsychiatrists.

Thanks to "dumb" psychiatry, many of us fare horribly on our meds. (A quick scan of my blog posts here backs this up.) Psychiatrists turn a deaf ear to patient complaints, which is the best way to mint an antipsychiatrist.

For what I guess is the vast majority of us, our meds make us better but not well. Again,too many psychiatrists don't appreciate the distinction. So we get a lot of frustrated patients whose lives aren't improving.

Similarly, due to side effects, for many of us, our meds interfere with our recovery. Again, psychiatry is largely deaf to this.

But then a lot of us figure out how to get well and stay well using meds combined with therapy, lifestyle choices, support, mindfulness, and other strategies. Some may reach the point where their recovery techniques are so well established that they may not need meds any more.

So, we are spread across a vast spectrum. And there is a legitimate basis to antipsychiatry, smart antipsychiatry. And going off meds may be a healthy choice for some.

I'm looking forward to delving further into these issues with you and other readers here.

Anonymous said...

Hi, Therese and others-- I would urge you to take a look at my colleague Richard Berlin's new book, "Poets on Prozac". It shows clearly how medication, in combination with psychotherapy, can be very helpful in fostering creativity, among artists and writers who otherwise would be crushed by severe depression. The book also gives the lie to the romantic myth that major depression is a heightened state of artistic and spiritual awareness that is quashed by antidepressant medication. (Dr. Peter Kramer took a similar approach in his book, "Against Depression").

As I have argued on the Psychcentral blog site, the "Devil or Angel?" view of psychotropic medication is a false choice.

Like fire--which can heat your house in the winter, or burn it down, if used improperly--medication is neither "devil" nor "angel". However, when used judiciously in the context of careful diagnosis, close monitoring for side effects, and a supportive professional relationship, medication can often be life-saving. --Ronald Pies MD

Anonymous said...

Many people are being cured of depression without medication. Those who need meds should take them but you can cure depression and suicidal thoughts. Our site has been doing just that. It is a combination of Science and Faith to heal.Many people do not know the power of the mind to control the brain.

John McManamy said...

Hi, Spirithappy. Just had a quick look at your blog. Congratulations. You're out there informing people and helping in their recovery. Meds are simply a choice, not the only choice, and they're not for everyone. Moreover, I contend you are not going to get good results from meds if you fail to resolve your underlying issues and put a range of recovery tools into play. Spirituality figures very heavily in both my healing and recovery. And the science validates the spirituality.

I think it comes down to this:

Certain people don't believe in anything or stand for anything. Nothing works. They are essentially nihilists.

Others have an either-or attitude. It has to be one or the other, not both. So if you're for A, you have to be against A.

Most of us see possibilities in a range of choices. But the first two groups of people can't comprehend how we can think this way. It's either purely nothing to them or all or nothing.

Anyway, I've blabbed on long enough. Many thanks for contributing to the conversation. Please come back to add your wisdom and insights. I regard you as a very valued member here and will do my best to make you feel welcome.

John McManamy said...

Hi, Dr Pies. Your reputation has proceeded you. Very happy to have you here. I fully concur, but I do feel compelled to challenge you on one point:

I do see value in mild depression. I say this from the point of view of someone who has lived it. In this state, I can achieve a certain level of calm reflective focus that allows me to marshal my thoughts in ways I cannot when my brain is running faster.

I wrote my book, "Living Well with Depression and Bipolar" in a state of situational depression, following the 2004 election. I like to joke I owe the book to George Bush. (Suffice to say, I'm too happy to take on a book project right now.)

On one hand, the depression aided my writing. On the other, my writing pulled me out of my depression. I'll be quick to add I was on a mood stabilizer at the time (but no antidepressant).

I will also hasten to add that for me writing is impossible (as just about everything else) when my depression worsens or when my energy levels drop (which is probably my "not-sad" version of depression - believe me I have more words for my depressions than Eskimos do for snow).

I guess what I'm saying is that I have found a functioning range from hypomania to mild depression to shades in between where I function quite well - but in different ways - to my advantage. The range is probably greater than what clincians would be comfortable with, but it works for me.

One more thing to add. I was last suicidally depressed 10 years ago, and I know it may happen again. Believe me, if that happens I will feel the same way I did then - give me the goddamn pill.

I hope to amplify these points in future blogs, and am looking forward to your comments.

Anonymous said...

honestly? I am quietly outraged that people who have not experienced what it is like to not be able to string a sentence together; to walk across my house without a string to follow, because I forgot how; to loose the thread of coherency... the gift of coherent thought is a precious thing, and until you have lost it, you have no idea *how* precious, or how grateful I am to have the option of an antipsychotic to weave them back into a whole cloth... let them judge me after experiencing the terror, discomfort, and just plain inconvenience of the "bad trip" that my brain is on, 24/7... I want a life too! Don't they GET their privilege??? GRR!!!

cretin said...

I have to agree wholeheartedly with "GRR!!!" I find it frustrating about those who believe that the problem of mental illness can be solved by defining it away. Either those who say this haven't ever suffered from one of these illnesses or they suffer from an illness and have lack of insight that their bizarre behavior and thinking are a problem that can be remedied. For the latter, I have sympathy. For the former, learn more about mental illness from those who suffer (and see how real they are) before you talk.

John D said...

John -

I agree that prevailing attitudes in mental health blogging are all or nothing. I can understand the terrible experiences that many have gone through at the hands of the psychiatric profession with misdiagnosis and mindless, severely damaging prescriptions. What I don't understand is the sweeping condemnation of all western medical research and the evangelical fury directed against those who have different experiences and opinions. As you say, they aren't the only ones. I also see a lot of contempt for natural and eastern approaches on the other side, and I don't get the certainty of both sides. I'm oversimplifying, of course, since there are many shades of opinion in between these two.

I wish people could just accept the reality that we don't know everything about depression and join in the common need to keep probing and testing until we find something that works for each of us individually.

Thanks for this discussion. As always, extremely valuable.


John McManamy said...

Hi, Anonymous. Absolutely agree. There are days when my brain literally does not boot up. So when someone who has no clue presumes to know what is going on in my head, presumes to have all the answers, presumes to know what is good for me, presumes to speak for me ... let's put it this way - the more they presume the lower I rate their IQ.

John McManamy said...

Hi, John D. Love your comments. You need to copyright "evangelical fury." And you're right - I don't get the certainty of both sides, either. In the ten years since I have been writing on my illness, I have witnessed the mapping of the human genome, the identification of suspect genes, the isolation of brain pathways that affect certain behaviors, new meds on the market, new ways to apply old treatments, diagnostic refinements too numerous to mention, the rise of the recovery movement, and on and on. What this says to me (from the point you raised) is we're still learning. We're all changing how we think as we go along. And we must all be willing to assume we will be thinking a lot differently a year from now, two years from now.

And we need to support each other as we look for answers. (Our lives depend on it.)

I've been very remiss in not putting "Storied Mind" on my blog roll. I just corrected the oversight.

Readers: You can check out John D's excellent blog by going to the blog roll or clicking the link to his name on his comment.

Anonymous said...

Hello, John--Thanks for the welcoming comments. I am not sure we really disagree on the matter of "mild" depression, though perhaps we have some semantic and definitional issues to hash out. You indicate that, "I do see value in mild depression. I say this from the point of view of someone who has lived it. In this state, I can achieve a certain level of calm reflective focus that allows me to marshal my thoughts in ways I cannot when my brain is running faster..." This is your experience, John, and nobody should disparage it!

Perhaps what you call "mild depression" is what others would call "equanimity". The ancient Stoics used the term "apatheia" to describe something like what you do, in your description of "calm, reflective focus". (The stoic term should not be confused with our modern word, "apathy"--it is closer to "balanced and reflective equanimity.").

I also believe that sorrow--as distinct from clinical depression--is another mood state that can sometimes lead to very productive work. Some of my poems are written in mild states of sorrow, in which I am able to harness that emotion in the service of art. You may be interested in reading my piece on "The Anatomy of Sorrow", and how it differs from clinical depression, on the PEHM website.
The URL is:

Thanks for your thoughtful approach to these matters.

Best regards, Ron Pies MD

P.S. You may also be interested in my book on the Stoics: Everything Has Two Handles: The Stoic's Guide to the Art of Living.

John D said...

Thank you, John! -

I'm honored and humbled. Your work is such a great example for the rest of us!

All my best to you -- John

Anonymous said...

It's amazing how people are antipsychiatry. Do they believe we are taking meds for fun?? To people like Peter Breggin, I beg to know what on earth are us bipolars supposed to do when we get manic if not take psychotropic medication. He doesn't say in his book because they have no solutions or even a simple understanding of bipolar disorder. Like all bps, I would gladly give up meds if it was an option. It is not.

John McManamy said...

Hi, Anonymous. Spot on. Peter Breggin would make sense if he stuck to his humanistic commentary. Certainly, our pressured lives are a cause of much unhappiness and a lot of mental illness. My blog today makes this very point.

And Dr Breggin has valid points that meds have been over-hyped while their dangers have been played down. And if he stuck to that his views would be in the mainstream.

But then he has to go on record as saying their is no biological basis to mental illness.

In short, the guy is clueless. If we followed his advice, we would all wreck our lives quitting our meds.

Many people learn to manage their illness without meds, but this is a long process taking years to master and is full of high risks. Moreover, there are no guarantees. To simply advise people to go cold turkey on their meds with no recovery tools in place, with no mastery of the necessary cognitive skills, is highly irresponsible.

I've been around way too many people where giving up meds is simply not an option. Breggin and his antipsychiatry followers obviously have never taken the trouble to listen to these people.

Welcome to "Knowledge is Necessity." Keep posting.

Anonymous said...

You're giving Stan a bigger podium than he deserves.
He's a provocateur who's done nothing in life aside from fighting with everyone and bitching all the time.

I was his friend a few years ago, many were NO ONE is anymore...


John McManamy said...

Hi, Sal. I totally agree with you about giving people like Stan a bigger podium than they deserve. I would much rather be writing about issues that relate to our self-knowledge and our recovery, but every once in a while I need to draw attention to the idiots who claim to speak in our name.

As your comments imply, we are dealing with very unpleasant people who do not have their behavior under control.

Just about everyone with a brain is sick of them, judging by the comments to this blog post and the number of visits this post has drawn.

Every once in a while, tough, I feel compelled to confront their stupidity with facts, but - be assured - I will never lose sight of what this blog is really all about.

Welcome to "Knowledge is Necessity," Sal. Please keep coming back and posting.

John McManamy said...

To Herb:

Hi, Herb. I absolutely agree with your sentiment in the last paragraph of your comment, but I had to edit it out, as it's the kind of thing one says in private rather than public. Otherwise, here's your complete post:

“You're giving Stan a bigger podium than he deserves.” --- Sal

I certainly would agree with Sal. Unfortunately and in my opinion Stan also utilizes his podium to be prosecutor, judge, jury and hangman all in his own mind. Dissent and/or differing thoughts on his forum are strictly denied.

In this instance the title of his blog sums up the situation in my opinion, “Is Something Not Quite Right With Stan…” only he does not answer the question directly in the affirmative which I believe is evidenced in much of his dialog with himself.

herb said...

Dear John,

In this instance thank you for the editing and I do apologize. I did realize after reading your piece, the comments and then hitting the send key the inappropriateness of my remarks much like some of those I object to as I read a number of other forums.

Once again thanks and keep up the good effort to share a more balanced and reasonable perspective not only on the serious issues of major mood disorders but the horrific nature of these illnesses as well and the extreme difficulty of obtaining some degree of wellness as well as long-term remission.


John McManamy said...

Hey, Herb. Your remarks weren't inappropriate and you don't need to apologize. Your last paragraph simply needed editing out. I know how you feel, and what you wrote is a pretty accurate reflection of what I think and what a hell of a lot of us think.

And be assured - you are safe here. Every comment gets vetted by me before it gets posted, so the kind of unconscionable personal attacks you were subjected to on other sites won't happen here.

Anyway, welcome to "Knowledge is Necessity."