Saturday, 1 August 2015

Interview with Dr. Burstow on

Probing psychiatry and the business of madness

What kind of society do we need to create so that people will thrive rather than feel alienated?

 | JULY 30, 2015
Probing psychiatry and the business of madness

Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting

by Bonnie Burstow
(Palgrave Macmillan, 
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A revolutionary new book on psychiatry, Psychiatry and the Business of Madness: An Ethical And Epistemological Accounting by Dr. Bonnie Burstow, was recently released by Palgrave Macmillan and has already drawn major conclusions and had huge societal implications.
The book deconstructs psychiatric discourse and practice and challenges the reader with such conclusions as: There is no credible basis for a single "mental disorder" and the drugs prescribed do not correct but create chemical imbalances.
Burstow challenges the reader to examine how society addresses certain problems and perhaps if we need to abandon psychiatry and rebuild lives together.
Lauren Spring, art-based trauma specialist and a doctoral student, sat down with the Burstow to discuss her latest book and the conclusions and implications it has achieved.
This is an abbreviated version of the interview.
Why do you feel this book is important for people to read now?
To be clear, the problems illuminated didn't just emerge. While I realize that this is contrary to people's image of psychiatry as a necessary service, as the book demonstrates, psychiatry can be roughly characterized as a regime of disinformation, intrusion, damage, and control -- in other words, there is a problem here; and the problem has been serious a long time. People are being treated as if their ways of being in the world, admittedly often troubled ways, are medical disorders, when in point of fact, they are not.
In the process, people are being brain-damaged and their lives substantially reduced. That said, what makes this particularly urgent is that psychiatry is a growth industry and so even more people are being damaged and diminished.

Bearing that in mind, who do you think should read this book? Who did you write it for?
I wrote it for psychiatric survivors, for their families, for professionals, for scholars. But first and foremost, I wrote it for members of the general public. This is our society: We have given immense authority over people deemed mad to this industry which is, in essence, declaring ever more and more people crazy, which is not solving but both creating and exacerbating people's problems in living. It's time for us to rethink and rescind that authority.

One of chapters that stuck with me most was that one about the health-care team, and this idea you bring up of professionalization. What I thought was very interesting was that you weren't demonizing the individual practitioners, but placing them in the context of this larger system. Could you speak to that?
The purpose of mental health professionalization is to serve the professionals; the purpose of the related industries to serve the industry -- and individual practitioners-in-the-making are partially unwittingly sucked into this.
To put this another way, people go into these different disciplines, in many cases, out of a heartfelt desire to help. And slowly but surely, they get socialized into modes of thinking that have them acting in these destructive ways.
In concert with this, just as professionals control the so-called mentally ill, they are themselves controlled. In this regard, I interviewed a large number of people from different disciplines that work in "psychiatric institutions," members of "the mental health team," as it's called. And what I discovered is that there's a party line, and people are more or less forced to toe that line. A nurse, for example, could not just ask other team members, "Why are we immediately turning to electroshock with this patient?" Indeed, one of the nurses interviewed in my research says, she was called on the carpet just for asking that question.

You give a very comprehensive history of the origins of psychiatry. And of course, historically, women were often psychiatrized for behaving in certain ways…or just existing in the world, right?
Women were psychiatrized either for stereotypically being women, or for veering too far from the stereotypes. Either one. As for what's happening now, today, there is no question that there are stereotypical women's diseases -- e.g., "borderline personality disorder" -- and there is no question that women are way more likely to end up being given a "disorder" than a man, also to be given more serious ones. That's true, I would add, of oppressed people in general. Of racialized people, poor people, trans people, etcetera. That noted, there is also a degree to which psychiatry is nonetheless an equal opportunity oppressor, in the sense that it is quite happy to psychiatrize anyone. With psychiatry's interest in continual expansion, that's the new reality that we are facing -- everybody is in jeopardy.

What role do you see the pharmaceutical industry playing in modern day psychiatry?
The pharmaceutical industry, for all intents and purposes, is modern day psychiatry -- all else are "add-ons." What's important to understand here is that in 1970s psychiatry found itself in danger of disappearing for non-medical professionals were frankly better at helping. Its solution was to hyper-medicalize -- that is, to create more and more the false appearance that what it was doing was medical.
In this drive to medicalize, the one thing that doctors are most noted for -- giving drugs -- became focal, for emphasizing it would really make their work look medical. Enter the foundationless claim of chemical imbalances and the drug push. Now we have an unholy alliance between psychiatry and the pharmaceutical companies, whose ultimate interest of course, is profit.

You refer in the book to the DSM [Diagnostic and Statistical Manual of Mental Disorders] as a "boss text." Could you elaborate?
As a central text, it sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they're going to be honing on questions that follow the logic of the DSM, or to use their vocabulary, the "symptoms" for any given "disease" they're considering.
In the process it rips people out of their lives. And so now there's no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed.
In essence, the DSM decontextualizes people's problems, then re-contextualizes them in terms of an invented concept called a "disorder."
Let me give you an example. "Selective Mutism" is a diagnosis given to people who elect not to speak in certain situations. So, if I were a non-psychiatrist -- that is, your average thinking person who is trying to get an handle on what's going on with somebody -- I would try to figure out what situations they aren't speaking in, try to find out if there's some kind of common denominator, to ascertain whether there's something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example, a person of colour going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, "Selective Mutism" is a discrete disease.
So, according to psychiatry, what causes these "symptoms" of not speaking? Well, "Selective Mutism," does. Note the circularity. That's what all the "mental disorders" are like: No explanatory value whatever, just circularity -- and yet they have authority in law. And as such, they authorize what gets done to people.

One of the things so remarkable about this book is you're helping us understand through history. Why did you think it important to open the book with a history of psychiatry?
If we do not know where something comes from, we do not know where we are. So I wanted readers to see: How did decisions really get made? What was really behind them? Once you get through the history chapters, you have a sense of the territory.

Absolutely. I learned a lot from reading those chapters. To skip to the end, your final chapter -- and it's beautifully written and really sparks the imagination -- is about a world without psychiatry. Could you discuss that?
Questions that we need to grapple with and that are posed in this chapter are: What kind of society do we need to create so that people will thrive rather than feel alienated? How do we reconstitute society so that everyone helps everyone else and so that we deal with problems together rather than targeting individuals and having those targeted folk consigned to experts? In essence, how do we live together in kinder, more accepting, more participatory, and more egalitarian ways?

One final question: How do we stop seeing psychiatrists as heroes?
By being honest about the invalidity and the harm being done; by looking at the diminishment of community that happens when we hand the power to govern ourselves over to experts; by once again daring to dream. If we start doing that, might we not then individually and collectively be able to bring ourselves to admit that the rise of psychiatry was a colossal misstep?

For details about the research underlying this book, see
Dr. Bonnie Burstow is a faculty member at Ontario Institute for Studies in Education, a philosopher, a social theorist, a feminist therapist, an author, and a long time anti-psychiatry theorist and activist. Her books include: Psychiatry and the Business of Madness, Radical Feminist Therapy and The House on Lippincott, as well as two anthologies of which she is first editor: Shrink-Resistant and Psychiatry Disrupted.

Lauren Spring is a doctoral student at Ontario Institute for Studies in Education, where she is conducting extensive research into military trauma, specifically focused on the Canadian military. She is also an actor, a theatre director, a critic of psychiatry, and an art-informed researcher. 

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Dr. Paula Caplan Review's Dr. Burstow's Book in Psychology Today

Bonnie Burstow’s brilliant, comprehensive, new book, Psychiatry and the Business of Madness,* is part of a tradition of trenchant critiques, including the great feminist psychologist pioneer Phyllis Chesler’s book Women and Madness in 1972; Jeffrey Mousaieff Masson’s The Assault on Truth in 1984; Peter Breggin’s Toxic Psychiatry in 1991; Bob Whitaker’s Mad in America in 2001 and Anatomy of an Epidemic in 2010; and James Davies’ book, Cracked, in 2013.  There is the brave work of attorneys Jim Gottstein and Tina Minkowitz, the late anti-electroshock activist Leonard Roy Frank – who taught me never to use the term “ECT,” because the “T” stands for “therapy,” MindFreedom founder David Oaks, Will Hall, the tireless multi-sphere, activist and survivors’ encyclopedia Amy Smith, and many others who work to expose abuses in the systems that are officially supposed to reduce emotional suffering and sometimes do that but often increase it.
I am a clinical and research psychologist and belonged to the American Psychological Association until I resigned because of their allowing psychologists to participate in torture and because of their frantic, well-funded push to get states to allow psychologists to prescribe psychiatric drugs. While still a member, I stood outside the annual convention one year and realized I was loathe to enter. Many psychologists and other therapists are humane, respectful, caring, and careful to avoid dogma and dangers to those they try to help. But Burstow shows with scrupulous care the ways that various systems make such therapists all too rare, and she lets those who have been harmed speak up in heartbreaking detail. As a result, instead of reading that Irit Shimrat tore off her clothes and ran down the hall of her apartment building banging on doors to warn people of the dangers or war…and thinking to ourselves, “Well, she was clearly nuts!” Burstow gives us Shimrat’s own words and then points out, in effect, how strange it is that so few of us are in close enough touch with the horrors of war that we bang doors in warning. We would do well to consider this.
Burstow does not romanticize what some people call madness, and she lets us in on the acute fears and confusion and other kinds of suffering that some people experience. Her entire book is aimed at revealing how traditional mental health systems and their affiliates (e.g., the diagnostic juggernaut, insurance companies, governments, courts, intake and other official forms, Pharma) too often prevent us from allaying the suffering and way too often make it worse.
The title of Burstow’s book refers to psychiatry, but she describes how also psychologists, social workers, and nurses sometimes reduce suffering but often dehumanize sufferers, drug them, shock them, inflict various kinds of physical and psychological violence on them. Depressingly often, I have also heard marriage and family therapists, counselors, and even clergy – for heaven’s sake, clergy! who are supposed to know oppression andspiritual or existential crisis when they see them!  -- leaping to assign or perpetuate psychiatric labels, misinterpret behavior in the most bizarre of ways, and push drugs even when they are harmful and isolation. Something is very wrong when a minister describesgrief over the loss of a loved one as a Major Depressive Episode, as the DSM-IV did (on the fourth page of the listing of that category).
Burstow takes us through some of the powerful forces that help maintain a harmful system and, using heartbreaking quotations from those who have been harmed,  reveals the human costs. She mentions how media actively promote dangerous so-called treatments, and I want to mention the role of major media in a  recent, mysterious failure to report the greatest corruption in the mental health system in decades. Columbia University medicalethics expert Dr. David Rothman wrote an expert witness report scrupulously documenting this: In 1995, the very year after DSM-IV appeared, three powerful psychiatrists were paid nearly $1 million by Jansen Pharmaceuticals to write a “Practice Guideline” for treating Schizophrenia, and the guideline – as promised – had the conclusion that Jansen’s new drug Risperdal was the best option. As Dr. Rothman noted, this was in utter disregard of what the research showed. Besides the guideline, what the three men did for their pay was to create a detailed program for marketing Risperdal by – among other things -- bringing hired-gun psychiatrists to give “Continuing Education” courses to promote the drug.  Risperdal is one of the most dangerous of all psychiatric drugs.   Most people are unaware of this corruption, which I call “Diagnosisgate.”** This is because although there were five major media stories about the Rothman Report, in not one were the three psychiatrists, their “practice guideline,” or their nearly million-dollar pay mentioned. In my article called “Diagnosisgate,” I said it was an unexplained mystery why this was, but despite calling attention to the media’s blackout, that blackout continues.
Another major player in concealing harm is the legislator, because it is so easy to propose laws and earmark funding that perpetuate the traditional approaches, playing into the common fear that deviating from the “standard of care” – primarily psychotherapy and drugs -- must be dangerous.  And in our chapter in Bias in Psychiatric Diagnosis,*** Jeffrey Poland and I wrote, as does Burstow, about a number of interlocking systems that perpetuate harm in the mental health system, and our focus was on psychiatric diagnosis. We included as the perpetuating entities some of those that Burstow examines, as well as Medicare and Medicaid, contemporary people’s desperate need in their overly busy lives to find silver bullet answers to their problems and a deep-seated and unquestioning belief in science/medicine/technology.
Burstow presents an entire set of wonderful, and wonderfully radical, proposals for transforming the ways we deal with people who suffer emotionally, as she will tell you. I heartily endorse them all, for they are about the importance of love, respect, compassion, and wholehearted listening to those in our communities…and to strengthening our communities.
I want to highlight both the most fundamental cause of harm and what we can do about it. Every problem in the mental health system begins with psychiatric diagnosis. After all, until they have labeled you mentally ill, they are not supposed to treat you, and once you are labeled, there is little they cannot do to you. As I learned from my two years on two DSM-IV committees, psychiatric diagnoses are unscientific(link is external), do not necessarily lead to reduction of suffering, and carry enormous risks of harm, including deprivation of every conceivable human right. “Patients” are socialized to feel grateful that their alleged mental illness has been named, and they are virtually never informed that getting a label can destroy their lives, so there is no informed consent. Nine people filed complaints about harm from psychiatric diagnosis with the American Psychiatric Association’s ethics committee, and these were dismissed with no attention to their merits. The Civil Rights Office of the US Department of Health and Human Services did the same with complaints that we filed. We have therefore demonstrated that not only is psychiatric diagnosis totally unregulated but that the one private entity and one government entity that by all rights ought to regulate it, redress harm, and prevent future harm, refuse to take a single step to do so.
Many years ago I proposed holding Congressional Hearings(link is external) about psychiatric diagnosis as a major step toward exposing its harms and creating a national conversation about what’s to be done.
Burstow describes hearings about harm in the system and hearings about electroshock that were held in Canada. One thing we can all immediately do is to follow this lead and demand such public hearings in our own countries and on global scales.   
*Burstow, Bonnie. (2015). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave Macmillan. is external)
** Caplan, Paula J. (2015). Diagnosisgate: Conflict of interest at the top of the psychiatric apparatus. APORIA:The Nursing Journal 7(1), 30-41. is external) 
*** Poland, Jeffrey, & Caplan, Paula J. (2004) The deep structure of bias in psychiatric diagnosis. In Paula J. Caplan & Lisa Cosgrove (Eds.), Bias in psychiatric diagnosis. Livingston, NJ: Jason Aronson.
©Copyright 2015 by Paula J. Caplan                    All rights reserved

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