The war on grief

by Robert D. Stolorow

traumaThe DSM5, the most recent version of psychiatry’s diagnostic bible, makes it possible to classify grieving that endures beyond a rather brief span of time as a mental illness.

This pathologizing of grief has ancient roots extending back at least as far as the Stoics, whose stern ascetic morality preached a perfect indifference that eschewed all passionate attachments. The ideal of selfless asceticism was carried forth in early Christianity, showing up dramatically, for example, in the Confessions of the prominent 12th century monk, Saint Bernard, who was wracked with guilt over his grief for his beloved dead brother. His brother, after all, was enjoying eternal happiness in heaven, so Bernard could only feel his grieving his loss as a manifestation of a wicked selfishness on his own part.

The pathologizing of grief was continued by the philosopher Rene Descartes, usually considered to be the initiator of the Enlightenment and Modernity. In letters to Princess Elizabeth of Bohemia and Constantijn Huygens, he warned that sadness and grief could cause serious physical illnesses, and he recommended a form of mental discipline—reminiscent of both the Stoics and contemporary cognitive-behavior therapies—in which the imagination was to be directed away from the sources of emotional pain and toward objects that could furnish contentment and joy. In the current psychiatric and medical climate pathologizing grief, psychiatrists (and even general practitioners!) are conflating painful feelings with clinical syndromes and prescribing anti-depressant medication for naturally occurring intense or prolonged sadness and grief.

Pain is not pathology,” I wrote in my book, Trauma and Human Existence. The traumatizing impact of human finitude, as disclosed in the loss of a loved one, is not an illness from which one can or should recover. The enormity and everlastingness of the grief following such a loss are not manifestations of psychopathology; they are a measure of the depth of love for the lost beloved. Traumatic states of sadness and grief can devolve into clinical depression when they fail to find a context of emotional understanding—what I call a relational home—in which they can be held, borne, and integrated. In a psychiatric climate that pathologizes grief and that advocates treatments aiming at emotional riddance, such a relational home for emotional pain is becoming ever more difficult to find. Such a circumstance is actually likely to increase the incidence of clinical depression.

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Copyright Robert Stolorow

Robert D. StolorowRobert D. Stolorow, Ph.D.. is a Founding Faculty Member at the Institute of Contemporary Psychoanalysis, Los Angeles, and at the Institute for the Psychoanalytic Study of Subjectivity, New York City. He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (Routledge, 2007)  and coauthor of eight other books. He received the Distinguished Scientific Award from the Division of Psychoanalysis of the American Psychological Association in 1995, the Haskell Norman Prize for Excellence in Psychoanalysis from the San Francisco Center for Psychoanalysis in 2011, and the Hans W. Loewald Memorial Award from the International Forum for Psychoanalytic Education in 2012.  

Grief need not be pathologized even if it takes a long time. A post with commentary and more links to posts on grief: Grief is subversive

DSM‘s Somatoform Disorders: millions more might be diagnosed

dsmOn Dr. David Healy’s website from yesterday there is an article about the very problematic Somatic Symptom Disorder category in the DSM 5. I’ve written about this before because it’s of particular interest to many folks who’ve suffered iatrogenic damage from psychiatric drugs. Psychiatric drug withdrawal syndromes are sometimes devastating crippling physical illnesses that can last months and years. We have all faced being told our issues are psychiatric. We have routinely suffered from little or no care from our health care providers. We have had to take care of each other completely out of the system. Remaining in the care of doctors has often been dangerous. Somatic Symptom Disorder category further institutionalizes this dangerous trend.

One of the common manifestations of debilitation when struck with withdrawal syndromes are numerous, often bizarre, acute, painful and disabling physical sensations. They include varieties of neuropathies and parasthesias. They are not in the patients head.  And since the psych drug use caused these disabling symptoms prescribing more drugs to cure them is exactly the wrong way to go but it’s what psychiatrists are inclined to do. This, of course, already happens. Many people are wrongly diagnosed when they start manifesting adverse reactions or acute responses to withdrawal from drugs.  They are routinely disbelieved when they start reporting such adverse events. The phenomena of protracted withdrawal syndrome is widely denied. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

From Dr. David Healy’s site, by Richard Lawhern:

With SSD,  you can be labeled with a mental problem simply because you have deep distress about your health that a doctor judges to be “excessive” or the doctor thinks your life has become dominated by your illness and symptoms. The same label may be applied to you if a doctor considers you as “over-involved” in the symptoms of a child for whom you are a care-giver. Cases have already occurred in which children have been removed from the custody of parents deemed to have facilitated their “illness behaviors”.

While psychosomatic disorders appear in previous editions of the DSM, the new SSD is particularly problematic. The scope of the disorder and diagnostic criteria are greatly broadened from the DSM-IV. SSD may now be applied to patients with either diagnosed or undiagnosed problems. Only one criteria of several need to be applied as a basis for the diagnosis.

There is reason to believe that SSD may be widely assigned to patients in the early stages of relatively complex medical problems such as Lupus, Lyme Disease, cancer, diabetes, cardiac problems, Chronic Fatigue Syndrome, Irritable Bowel Syndrome or fibromyalgia. Many fibromyalgia and CFS patients already report being told that their medical problems are primarily emotional rather than medical in origin. –  (read more)

The plight of so many who have taken psych meds getting seriously ill is not mentioned in the article. I have several articles on this blog that talk about the common features of withdrawal syndromes with illnesses like chronic fatigue and other serious autoimmune illness included in the above list. Psych drug withdrawal is strikingly similar to many serious chronic illnesses, all of which impact the autonomic nervous system which in turn cause broadly systemic issues in the body.

There is an ongoing failure to recognize the iatrogenic illness (medically induced physical illness) that these drugs often cause, especially when people withdraw from them but often simply as a result of going on and off them as is routinely done in the treatment of those who are called “treatment resistant.” The med “merry-go-rounds” that so many people experience in psychiatric care are quite often the cause of what gets called treatment resistance. The body/mind doesn’t like having its nervous system repeatedly jacked around. And that is what switching psych drugs routinely does. It seems that people who have histories of going on and off and switching meds a lot have a higher incidence of serious issues when withdrawing.

Because there is a long history of the health and well-being of those labeled with psychiatric illness being neglected already, these happenings are very serious indeed.

Those labeled with mental illness already have a very hard time getting their health care needs met and are routinely disbelieved even when reporting serious health issues. People have died as a result of not being taken seriously when they have serious medical problems. I have sadly witnessed such ill-treatment when I was working in social services. I saw more than one client die as a result. See:  Health care professionals discriminate

The Somatic Symptom Disorder institutionalizes this dangerous habit so that even more harm might come from this systemic discrimination. The antidote is education. Pass it on.

Learn more:

This article has now been published on Mad in America. If you have experience dealing with the sort of discrimination talked about in this article, please consider leaving a comment there.

Psychiatric labels and the bigotry/prejudice attached to them

bigotI get really tired of the stickiness of psychiatric labels. In spite of the fact that they are used inappropriately all the time, once people are labeled it’s very hard to lose the label and the bigotry and prejudice that accompanies the label.

This is true in medical files, but it’s also true in life. It’s true on this blog.

I’ve never owned the label bipolar on this blog. In fact I explicitly disown it in the early life of this blog. See: Undiagnosing Myself

Still, to this day, I’m referred to as mentally ill and bipolar all over the internet in routine fashion. I generally try to ignore it, but I really can’t. It sucks. I had a crisis as a young woman. That crisis led me to being inappropriately heavily drugged for many years. I am no longer on psychiatric drugs.

That crisis and the experiences that followed due to the psychiatric machine,  still mars the way people perceive me today in spite of the fact my mind is crystal clear.

I think this is true for everyone with psychiatric labels whether people embrace the label or not. Assumptions start being attached to us, for the rest of our lives. Whether people agree with their labels or not the bigotry and prejudice is ugly and it too often disallows truly seeing people for who they are.

I wrote most of this little post about a year ago. I just found it in my drafts file. It remains true so I’m posting it.

Bigotry and prejudice of all kinds are a sad reality that keep us from experiencing people as they truly are.

 Once you label me you negate me. – Kierkegaard

More articles on the prejudice against those who are labeled.

Make me normal

make me normalFrom indiegogo

…MAKE ME NORMAL, explores the rise in diagnosis of mental disorders and the boom of psychiatric prescription drugs, all set against the release of the new controversial psychiatric guidelines of the DSM (nick-named the “Psychiatry Bible”).  With 1 in 3 Americans diagnosed with a mental disorder and 20% (and rising) on prescription drugs, the film asks, what happened to normal? Or, even, what is normal? (read more)

This is from an indiegogo fundraising campaign Mitch McCabe, the filmmaker is doing. If you’re interested in supporting it visit the indiegogo website. 

Mental illness: five hard questions

Nikolas RoseProfessor Rose is one of our leading contemporary social scientists. Currently he is Professor of Sociology and Head of the Department of Social Science, Health and Medicine at King’s College, London. In the talk, Professor Rose characterises the ‘territory’ of mental illness today by posing five hard questions that seem to represent genuine empirical, conceptual, professional and ethical dilemmas. The questions are: Is there an ‘epidemic’ of mental disorder? Does the path to understanding mental disorder lie through the brain? What is the role of diagnosis and of diagnostic manuals? Should we seek early identification of those at risk of future mental pathology? What is the place of patients, users, survivors, consumers in the mental health system?

hat tip Mad in America

A thoughtful lecture indeed.  It’s a complex and academic analysis. I’m still watching.

Just for the record, this is not how I generally consider mental health issues, but it’s an interesting exercise to follow the discourse and I also believe  it’s important to be fluent in different methods of approaching these issues for the sake of dialogue and communication with everyone interested in the mental well-being of all of us on this planet today.

Neuro: The New Brain Sciences and the Management of the Mind — Nikolas Rose

Mental Health Europe makes important statement about DSM and bio-psychiatry (PRESS RELEASE)

From Mental Health Europe: this is the press release that can be seen on their website here:

europe_map_politicalWestern psychiatry is in crisis. The direction taken by the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5), due to be published later this week, has received ample criticism. Moreover, in disagreement with the American Psychiatric Association, the United States National Institute of Mental Health (NIMH), the world’s largest research institute, has announced they will no longer fund projects based exclusively on DSM categories. Unfortunately, while Mental Health Europe considers the NIMH decision to be the right one, by focusing almost entirely on neuroscience and on so-called disorders of the brain, the NIMH is missing out on the critical importance of user experiences to psychiatric research and to the practice of psychiatry.

Mental Health Europe is extremely concerned that the publication of DSM 5 represents another step in the increasing dominance of a wholly biological approach to mental health problems, supported by an enormous machinery of science, technology and economic interests. What is more, one of the visible consequences of this approach is the relative downgrading of psychological and social interventions, which support personal and social recovery. Moreover, psychological and social interventions are becoming dependent on the biological model, instead of responding to the needs and aspirations of mental health service users. Obviously, this is in contradiction with the social and human rights perspective of the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), now ratified by the European Union and by more than 100 countries worldwide.

Furthermore, Mental Health Europe is alarmed that the DSM 5 includes many diagnostic categories with questionable reliability, which increasingly medicalize normal reactions, such as grief or shyness. A label of psychiatric illness would therefore be imposed on people who would fare much better without one. Consequently, the manual could also lead to unnecessary and potentially harmful treatment, especially considering the relative ease with which potent psychotropic drugs are prescribed.

Therefore, Mental Health Europe denounces the exclusive use of biomedical approaches in the new Diagnostic and Statistical Manual. While science can be very useful for mental health and wellbeing, the simplistic and imposed application of partially explored, reductionist science can also impede understanding of the human condition and encroach on basic human rights.

There are many tried and tested psychosocial approaches to treating and supporting people with mental health problems, which have been neglected by the powerful political and commercial interests which dominate western psychiatry. Over the next few months, Mental Health Europe will be giving prominence to some of these through our newsletter and website, so that service users and their families can make informed judgements. Articles, research and conference summaries will be published, covering models which combine medical with other approaches, as well as models which are not at all medically based.

In light of the previous points, Mental Health Europe also calls on the World Health Organisation to take account of these widespread concerns in the forthcoming revision of the International Classification of Diseases, and to give much more weight to service user experience and psychosocial approaches in classifying mental health problems and in assessing the effectiveness of interventions.

“Mental health problems are not black and white. They can be fleeting or permanent, stem from a multitude of causes, and, depending on the individual person, respond to different interventions. The biomedical approach in the DSM 5 is thus restrictive and harmful, and should definitely be rethought,” said Karina Huberman, MHE Acting Director.

For more information, please contact MHE Information and Communications Manager Silvana Enculescu at silvana.enculescu@mhe-sme.org. MHE Senior Policy Adviser Bob Grove and MHE Policy Officer Yves Brand will be available for interviews.

NIMH is abandoning the DSM!

Another big WOW piece of news. I’ll let it stand alone. Thank you for alerting us Mind Hacks.

It’s not like Insel is generally an enlightened sort, but this remains fascinating! (updated thoughts below…it’s not as good as it seems, though tossing the DSM is still rocking the boat)

dsm5In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves. (READ THE REST)

UPDATE: I read the NIMH announcement.  (when I first posted this I had just woken up) As I said above, Insel is hardly an enlightened sort. This probably isn’t as positive as it sounds. Although acknowledging the limitations of DSM is good, what will eventually replace it is likely to be even more reductive, i.e. the criteria for diagnosis will likely become all biological based on genetics, scans and other kinds of testing without reference to anything involved outside the patient’s body.

That’s not to diminish the value of discarding conceptual categories. It’s not that long ago that mental illness was mostly classified as hysteria. In any case this is a shake-up and anything that undermines the credibility of the DSM at this juncture is a good thing.

Still the bottom line is that there is no understanding, still, of our deeply holistic natures and how EVERYTHING matters in our lives. Not just the biological.

More posts on the DSM on Beyond Meds here

Story of harm presented to the American Psychiatric Association and summarily dismissed

Watch the Stories of Harm the APA Refused to Hear: M.S.’s Story. 

This story is important and it happens ALL THE TIME. This sort of downslide into psychiatry that creates further illness rather than helping alleviate the suffering that one first brings to the psychiatrist. It’s disgusting that it’s not recognized. Truly horrifying. Since I’ve started working on this blog I can’t tell you how many hundreds of similar stories I’ve now encountered. The sad part is it happens much more often than is ever recognized. I can actually imagine psychiatric drugs being used responsibly. I can. But that they’re so routinely used with careless disregard means it’s just far too often simply plain dangerous to go see a shrink. This sort of nightmare scenario also happened to me…sucked me in for a good 20 plus years and left me acutely and chronically physically disabled for several years. I’m still recovering. My mind is clear now, thank god, since I disentangled myself and stopped taking the drugs, but my physical well-being is still very poor. We need to stop this from happening to so many people.

M.S. asked the American Psychiatric Association in the ethics complaint she filed to redress the harm done to her by diagnoses from their manual, the DSM, and to prevent future harm to others. The APA summarily dismissed the complaint with no indication of considering its merits, saying that there is no appeal. Although the practitioners treating her were partly to blame, if the DSM were honestly described as largely unscientific and unlikely to help but likely to cause harm, how different her life would have been. Even today, for her to have told her story on the video herself would have been too risky, in light of the way people who have been psychiatrically diagnosed are treated. To see how you can help, go to psychdiagnosis.weebly.com

For a history of the complaints that were put in front of the American Psychiatric Association’s ethics committee see here: The APA Refuses to Listen to Voices of People Harmed by Diagnosis 
 and Refuses and Refuses and Refuses, by Paula Caplan

My story on Dr. David Healy’s site: the aftermath of polypsychopharmacology (which also followed being diagnosed with a bogus illness from the DSM, so yes, my journey down this dark rabbit hole also started with a diagnosis that created havoc and harm in my life)

paula caplanMore of Paula Caplan’s work on Beyond Meds:

●  Healing Veterans: Paula Caplan
● Dr. Paula Caplan on how psychiatrists decide who’s normal
● What’s Wrong With This Picture? Psychiatrists’ Focus on Drugs and Emotional Distance: by Paula Caplan
● Emotional Healing Without Pathologizing or Drugging: a veterans day post
● Full Disclosure Needed About Psychiatric Drugs That Shorten Life
● Military families and psychiatry: what are we doing to the children of our military?
● What’s Wrong With This Picture? Psychiatrists’ Focus on Drugs and Emotional Distance
● Fattened by Pills

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