Tag Archives: Susan Inman

The Good, the Bad and the Ugly of Social Work

By Marvin Ross

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author of After Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

Here is the recommended reading:

Cohen, D. (2009). Needed: Critical thinking about psychiatric medications. Social Work in Mental Health, 7(1-3), 42-61.

Medawar, C. & Hardon, A. (2004). Sedative hell. In Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill (pp. 11-27). N.P., Netherlands: Aksant.

Whitaker, R. (2001). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Massachusetts: Perseus-p.3-19.

White, J., Marsh, I., Kral, M. J., & Morris, J. (Eds.). (2015). Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. UBC Press. – Introduction

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

 

Advertisements

Am I A Reductionist? Part I

By Marvin Ross

I must confess that I’m not really sure what that means other than that it has been an accusation leveled at  me. One of my advocacy colleagues told me recently of a conversation she had with a member of the mental health bureaucracy and my name came up. The bureaucrat said he read me and that I was a controversial writer (I try) but that I was a reductionist. I wasn’t sure if that was a complement or an insult.

Then, just recently, someone who did not like Susan Inman’s latest Huffington Post blog critical of the Hearing Voices Movement, accused her of also being a reductionist. I guess it is an insult. Ms Inman is the author of After Her Brain Broke: Helping My Daughter Recover Her Sanity which my company publishes. 

What does our being accused of being reductionists mean? Richard Dawkins, in The Blind Watchmaker (1996) said Reductionism is one of those things, like sin, that is only mentioned by people who are against it.” This was quoted in Reductionistic and Holistic Science by Ferric C Fang, the editor in chief of the journal Infection and Immunity.

The abstract for this paper states:

A reductionistic approach to science, epitomized by molecular biology, is often contrasted with the holistic approach of systems biology. However, molecular biology and systems biology are actually interdependent and complementary ways in which to study and make sense of complex phenomena.”

And then the paper goes on to say:

Few scientists will voluntarily characterize their work as reductionistic. Yet, reductionism is at the philosophical heart of the molecular biology revolution. Holistic science, the opposite of reductionistic science, has also acquired a bad name, perhaps due to an unfortunate association of the word “holistic” with new age pseudoscience.”

The author substitutes system biology for holistic biology because it lacks the pejorative nature of holistic. And I don’t want to try to give a precis of this paper but simply to say that molecular biology is an example of the triumph of reductionism. But holism goes back to Aristotle and the two are not mutually exclusive. Again, the author states that:

Each approach has its limitations. Reductionism may prevent scientists from recognizing important relationships……..Holism, on the other hand, is inherently more challenging due to the complexity of living organisms in their environment.” And, “When fecklessly performed, systems biology may merely describe phenomena without providing explanation or mechanistic insight or create virtual models that lack biological relevance”.

Furthermore, “It is difficult to imagine how a number of important scientific discoveries could have been made by any method other than a reductionistic approach.” However, the author points out that the “reductionistic and holistic methodological approaches have been coexisting and thriving for centuries. One can argue that Darwin’s theory of evolution represents an early example in which many reductionist observations on finches and domesticated pigeons were synthesized into a system that unified all of biology……….Nevertheless, there is no denying the revolutionary impact of holistic thinking on the field, both in calling attention to situations in which reductionistic approaches have been deficient and in the generation of new experimental approaches for the analysis of complex systems .”

There are many other sources on the reductionist/holistic dichotomy and you can peruse them if you wish. It is only through reductionistic scientific enquiry that we may find a specific and necessary cause  of a problem  though many other factors contribute. But, it is also wise to have a holistic perspective.

There is no either/or in our search for answers and explanations and to abide by one methodology while ignoring others, is stupid and narrow minded. So, thinking, as some seem to do, that they can dismiss my views or those of Ms Inman as reductionist serves absolutely no purpose whatsoever. It says far more of them than it does of us.

Anyone who is honestly seeking truth needs to be open to reasoned arguments and to the unbiased evaluation of fact.

Next On Models, Concepts, Power, and Politics – Part II by Dr David Laing Dawson

Mental Illness Literacy

By Marvin Ross

In a recent Huffington Post blog, Susan Inman (After Her Brain Broke: Helping My Daughter Recover Her Sanity), wrote about the need for greater literacy about mental illness. And, like me, Susan often gets inundated with comments from opponents. One was from John Read, a psychologist at the University of Melbourne.

Susan was arguing that we need greater understanding of the biological causes of serious mental illness and I agree. Read, however, commented that:

“The evidence is over 50 studies all showing that biological beliefs increase fear and stigma. I’m afraid you are swallowing drug company propaganda, there is no evidence that these drugs prevent violence.”

When challenged to provide sources, he countered with:

“If anyone is interested in what the reserch (sic) says on this issue……

READ, J. (2007). Why promulgating biological ideology increases prejudice against people labeled ‘schizophrenic’. Australian Psychologist, 42, 118-128.

READ, J., HASLAM, N., SAYCE, L., DAVIES, E. (2006).Prejudice and schizophrenia: A review of the ‘Mental illness is an Illness like any other’ approach. Acta Psychiatrica Scandinavica,114, 303-318.”

In an article  that I wrote for the World Fellowship for Schizophrenia and Allied Disorders in 2010, I mentioned the Read approach. Basically that approach states that we should ignore the illness in favour of viewing mental health problems as part of our shared humanity. One of the research papers by Read that I commented on was a 2002 paper which compared the biological explanation of mental illness to a psychosocial explanation. And while Read points out that the psychosocial explanation helped reduce stigma more that the biological, he admits there was no statistical difference between the two.

This is the link to his first article that he cited in his comments to Ms Inman. You can decide but note the lack of objectivity in his title. Biological explanations are cited as ideology that are promulgated and schizophrenia is in quotes. The second paper he cited deals mostly with surveys  asking people what they considered to be the causes of mental illness. Many of them believed that the causes were psychosocial which just proves that Susan Inman is correct in wanting to see greater literacy.

But again, to prove his point, he says that a study that showed a video of a person describing their psychotic experiences increased perceptions of dangerousness and unpredictability in viewers. However, a video explaining the same experiences in terms of adverse life events, led to a slight but non significant improvement in attitudes by those who viewed it.

Again with the non significance. It means there was no difference between the two. The responses were the exact same! Someone who acts scary and displays very abnormal and aberrant behaviour is going to be shunned regardless of the explanation for that behaviour. He does cite a number of papers but they date from 1955 to the latest in 2005.

In my 2010 article, I quoted Dr Heather Stuart, an expert in stigma at Queens University in Kingston, Ontario who said that there have only been six controlled studies of stigma. One of them by Patrick Corrigan found that education did lead to improved attitudes. I could not find a reference to that paper in the one by Read.

As an example, those with advanced symptoms of Hansen’s Disease looked very frightening and were isolated from society. The Leper Colonies existed because no one understood the disease and were afraid they might get it too. But then, modern medicine came along, discovered Leprosy was caused by a bacteria, learned to treat it early and we no longer have people disfigured when treated early. We might still cringe at the thought of leprosy but likely no one has ever seen an advanced case.

In a similar vein, the solution for schizophrenia stigma is not to pretend it isn’t what it is but to provide treatment. As Queen’s University psychiatrist Julio Arboleda-Flores said in his 2003 editorial in the Canadian Journal of Psychiatry, “the best approach is to limit the possibilities for people to become violent via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence;” he writes that “this could be the single most important way to combat stigma.”

And one way to ensure that is to have greater mental illness literacy as Susan suggested.

Now I also have to comment on a post to Susan’s blog by someone who is continually criticizing both Susan and I for our writing on the medical model for schizophrenia. Suzanne Beachy did post a number of comments which you can see for yourself but my favourite is her announcement that another critic of the medical model, Rossa Forbes, has just announced that her son is cured of his schizophrenia.

It seems that his cure was delayed by their being “sidetracked by institutional psychiatry perpetrating the false belief that there was something gone horribly wrong with his brain and only they knew the magic formula to set things right again.” If you go to Ms Forbes blog, you will see her extolling how well her son now is which is wonderful. In fact, she says, he is so well that he has reduced his Abilify to half its dose and is planning to go completely off slowly over time. Abilify, of course, is an anti-psychotic used to treat schizophrenia and is prescribed by psychiatrists.

I am dumbstruck as I am with all the critics of modern science.