Wednesday, December 22, 2010

An Outline of Farce in the Public Mental Health System

As I see it . . .
This is just a partial list to get started with.  Not in any particular order.
  • Blind Advocates—There is a tendency among mental health workers to advocate blindly regardless of actual clinical need. This is far more true in the mental health system than is found in the developmental disability services arena or the addiction treatment arena.
    • Blind advocates will misrepresent the truth about their clients to potential landlords, employers and even other mental health professionals in order to get their client whatever he or she wants without consideration for the fact that by not addressing the underlying problems they are simply setting their client up for another failure.
    • Some professionals will implicitly or explicitly promote fraud as they look the other way when their clients lie about income and symptoms in order to maintain entitlements.
  • We’re All Disabled—creation and promotion of disability. Some mental health professionals seem to be of the opinion that any client who comes to them or their program should get cash disability payments. Some go so far as to misrepresent the severity of the clients' condition in order to help them get disability. Very little thought seems to be given to the fact that someone who is not truly disabled will ultimately be detrimentally affected by being told they are now disabled (and shouldn’t work) and by being escorted into the Social Security trap.
  • You Need My Help—nurturing or creating dependence on the therapist and the system. It is truly overwhelming how much of public mental health resources (Medicaid and Medicare) are channeled into treatment models that have no positive clinical outcomes except the promotion of more mental health services.
  • Cherry Picking—therapists and programs who are only willing to work with favored (i.e., easy-to-work-with) clients and unwillingness to work with clients with actual severe disabilities with difficult behaviors associated with their disability. Where does this leave people with severe disabilities? Overcrowded state institutions or the street. Where is the compassion?
  • Pseudoscience—use of pseudoscientic data to bolster vacuous treatment models. Just take a few examples, out of many:
    • Eye Movement Desensitization and Reprocessing—belief that having a client track a moving finger or object with their gaze while concentrating on a stress inducing thought will reduce symptoms of mental illness.
    • Neurolinguistic Programming—assumes that by tracking another's eye movements and language, an NLP trainer can shape the person's thoughts, feelings, and opinions (There is no hard evidence to back this up).
    • Emotional Freedom Technique—tapping acupuncture points with your fingertips. The principle behind EFT is that negative emotions can cause disturbances in the body's “energy field.” Your tax dollars hard at work, tap, tap, tap . . .
  • Diagnostic Fads—faddish use of popular diagnostic categories and treatment models. The result is overwhelming increases in certain diagnoses due to popularity rather than objective facts. There are a number of reasons behind diagnostic fashion crazes but the primary driving force seems to be a widespread culture of pathologization of day-to-day problems. People are increasingly demanding that personal and interpersonal problems be described through a disease model and treated with medications or other quick fixes. Added to this is the commercial pressure from the army of therapists out there looking for business and, of course, the massive influence of the pharmaceutical industry. Some examples of diagnostic fads:
    • ADHD—this seemed to peak in the Nineties and was driven by schools, parents and society at large moving away from traditional methods of child discipline and seeking new forms of behavioral control for the modern child (RitalinÒ). In its heyday, in the late Nineties, some elementary schools had upwards of 25% of young boys diagnosed and on these medications. Its popularity has diminished, only a little, because of the rampant problem of boys and girls on amphetamine-based medications growing up (all too quickly) into methamphetamine addicts.
    • Bipolar Disorder—this is a very real and serious disease. However, sadly, it is very poorly defined. Many professionals are confused by the diagnosis and do not really understand it. It has become a very convenient label to throw at anyone with mood and behavioral difficulties (gee, isn’t that the entire human race?). This diagnosis became very widespread in the Nineties and was, and still is, very popular among adults who just want something to deal with emotions that get in the way of professional and relationship successes. It got another boost in the 20-Ought decade when anti-depressant drugs were found to increase the likelihood of teen suicide. The solution? Yeah, we'll just slap a Bipolar label on ‘em and feed ‘em Lithium Carbonate for breakfast. Problem solved.
    • Dissociative Identity Disorder (AKA Multiple Personalities)—Where do you even begin with this one? So for one thing, it’s very very questionable whether this is even a real disease. But, the point I wanted to make here is that this diagnosis has mushroomed quite recently. You might remember the big implanted/recovered memory scandal of a few years ago? Yeah, well all those mentally unbalanced therapists who were driving that bus are still out there and still practicing. Now they don’t do the recovered memory thing anymore because they don’t want to get sued, but they are pushing this diagnosis hard. It is a sick, sick thing when a therapist plants and nurtures a mental illness in a client for their own emotional and financial gain.
    • Posttraumatic Stress Disorder—yes, this is real, but it is way overdiagnosed. Humans are, in fact, quite resilient. I am here to tell you that not everybody who has experienced trauma needs to take drugs or spend money on a therapist. PTSD is on the crest of a wave right now. There are some therapists out there who have reduced their professional vocabularies down to a single word: Trauma. Yes, understanding trauma is very important for promoting mental health, but in the hands of confused but well meaning professionals, it leads to drowning in past traumas with absolutely no clue about how to help a person recover and build resilience.
    • Autism Spectrum—another very real and very serious disease that has become exceedingly popular and chic among parents and even among adults who have only very minimal signs of the disorder.  Here is another case of individuals with severe disabilities losing resources to people who don't really have a disability
  • The Paradigm Pendulum—quick radical changes in paradigms based, not on science, but on politics, popular culture, political correctness, and economic incentives/pressures. This problem has plagued psychology/psychiatry from the very beginning. The human brain is maybe the most internally complex organ known to biology and empirical science (not psychology) is only now beginning to scratch the surface of this amazing complexity. So what has driven psychology/psychiatry over the past century? I don’t know what you call it, but isn't empirical science. So, lacking a true empirical basis, what drives these paradigm shifts? Ideology and wishful thinking, I say. That’s why the history of paradigms in psychology looks a lot more like the history of politics than it does medicine. There are thousands of theoretical models out there, most of whom bit the dust long ago, but there is a bigger pattern in which the culture seems to go back and forth between the two great paradigms of the biomedical model and the psychosocial model. In recent history, the biomedical paradigm gained overwhelming ascendancy in the Eighties and into the Nineties on the Prozac locomotive and the “chemical imbalance” explanation-for-everything. Now that’s out, the new slogan is “trauma,” and the psychosocial paradigm is king. But, the cracks in the façade are already developing and there is a building swell of genetics research that’s threatening the party-line. Look at your watch, give it 10-15 years and the medical model will be back on top again. You can put money on it.
  • I’m Not Mentally Ill But You Have to Support Me and Serve Me—psychiatric consumers and survivors who represent their own personal interests but packaged as social activism. How many times can someone unironically claim there is no such thing as mental illness, yet on the other side of their mouth, demand more and more services from the mental health system? It is a fact that very few people who publicly represent themselves as consumer/survivor activists have ongoing severe mental illness. As a consequence, the interests and needs of people with severe disabilities continue to go unheeded. Decades after “deinstitutionalization” we still have people with severe mental illness housed in deplorable conditions in institutions, prisons, emergency shelters, and the streets. Are these people represented by the self-styled activists? Not that I see. But, the full-time activists are marshalling all their energies to address their personal pet peeves while many of them fraudulently continue to draw down social security payments. Listen, Buddy, if your doing networking and activism 60 hours per week, you are perfectly capable of getting a job just like anyone else and you have no right to take public disability payments intended for people who can’t work.
  • Drug Money—psychiatric medications are big business, in fact, prescription drugs have the biggest profit margin of any major industry, even bigger than the petroleum industry. Where do they spend their money? Just like any for-profit industry, a sizeable portion of expendable resources goes into promoting their products. This certainly includes advertising. It also includes funding biased research that promotes their products; flooding journals and literature with redundant studies that promote their products; deceptive “public education” campaigns; creating and financing activist and consumer groups that promote their products; etc. You get the idea. It has a huge huge impact on beliefs and practices in the mental health field. When encountering McScienceÒ, buyer beware.
  • Let’s Play Pretend—politically correct professionals who willfully misdiagnose or simply avoid properly identifying personality disorders or any problem that fails the political correctness test. Borderline Personality Disorder, as one example, is often diagnosed, incorrectly, as depression, bipolar, PTSD, and dissociative disorders. This is pervasive and causes no end to problems in mental health programs where the actual issues are misunderstood or ignored. Conflicts occur between professionals resulting from attempts to address and discuss the problems while not being free to identify the problems properly. Resources are taken away from disabled individuals in order to support massive amounts of services to individuals who are not significantly disabled and may not even have a severe mental illness.


  1. Thanks Mr. Pill. I applaud your perspective which in the context of our presently hypersensitive society, will decry your words as being politically incorrect.

    Individuals who are interested in learning how entrenched Pharmaceutical companies are in this who facade for mental care, as well as the economy itself, should watch "The Marketing of Madness". After watching this I realized that even if the Pharmaceutical industry were to be held in check and psych professionals stopped over-diagnosing and over-prescribing, there would be economic consequences/corrections as or further far-reaching than what we saw in 2008-09.

  2. I know what it's like to have Bi-Polar and be thrown away by public mental "health" because people only wanted to treat what was easy, i.e. those not seriously mentally ill or without mental illness at all but minor issues anyone could have. I also know what it's like to have therapist tell me taking my medicare was a favor because it paid 50 dollars for a fifty minute hour instead of the egregious amount of 150, so really I should take care of them. It took me ten therapists to find one that took mediciare and used an evidenced based pratice - motivational interviewing. Most therapists don't use an evidenced based practice but people believe because they are licensenced they are competent when they are not. I also had a doctor years ago that he wanted to quit prescribing a medication another doctor had, because he said it was to expensive - when he was making almost 300 grand a year himself! Thanks for posting this article, most people in the field have excused professionals and blamed me and other clients.