Disordered Thinking – STOP IT!

There’s a Bob Newhart clip.  The client worries about being buried alive.  The clinician’s solution: “STOP IT!” https://www.youtube.com/watch?v=Ow0lr63y4Mw

What if it were that simple? You only had to change your mind. Exercise your option to do something different.  This is the second of a series of articles that makes the case for a 100% voluntary approach to mental health. If you want to start at the beginning, you can do that here:  Rethinking Public Safety – The Case for 100% Voluntary, http://www.madinamerica.com/2016/02/rethinking-public-safety-the-case-for-100-voluntary/

In this second essay, we take a look at trauma, and propose an end to ‘disordered’ thinking.  By the end of this article, we will be asking everyone – clinicians, politicians, law enforcement, emergency responders, families, friends, the general public – even those of us with labels – to ‘STOP IT!’ 

1.    Human needs are not disorders

For years now, the behavioral health community has maintained a ‘disordered’ perspective.  The idea is that people have pre-existing genetic, biochemical, mental or behavioral abnormalities. Those affected are irrational and susceptible to acting without regard to personal welfare or that of others. Aggressive treatment is required to correct or mitigate deficiencies, including psychoactive drugging and psychotherapy.

In 2011, however, the National Council for Behavioral Health blew the lid off this theory. In a special publication - nearly 100 pages in all – they ‘broke the silence’ on the impact of trauma in behavioral health.  They called on behavioral health professionals nationwide to recognize and address the prevalence of trauma in mental health, substance use, criminal justice and shelter settings.  They called attention to the fact that ninety (90!) percent or more of service users across these domains are ‘trauma’ survivors. Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote: “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.” Other kinds of ‘trauma’ including lack of access to basic human needs, widespread poverty and social marginalization were also noted.  

You can read the entire National Council publication here:  Breaking the Silence: Trauma-Informed Behavioral Healthcare (National Council Magazine: 2011:2), http://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf.  Another excellent resources is the 2014 TED Talk by Nadine Harris, MD: ‘How Childhood Trauma Affects Health Across a Lifetime,’ https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

2.    This is a social justice issue.

You may wonder why the word ‘trauma’ was put in quotes.  In recent times, the idea of trauma has been medicalized. It is now seen as a disorder -  something to be treated, even medicated away.  In actual fact, however, trauma is a social justice issue, not a medical one.  Vast numbers of behavioral health clients grow up without a way to meet basic human needs. Things like:

• reliable access to food and habitable shelter
• safety of person and property
• dignity, respect and fair treatment
• meaningful participation and voice
• the family means to make a living
• opportunities for development across major life domains
• human support to make sense of experience in their own way

These are people’s actual, life circumstances.  They would be matters of concern for anyone.  They represent core dimensions of existence.  Universal Declaration of Human Rights, http://www.un.org/en/documents/udhr/  Yet, many, many people feel insecure, ignored or even totally trampled on  - and with good reason - physically, emotionally, socially, economically, existentially.

Labeling trauma a ‘disorder’ in these circumstances is problematic to say the least.  Any conscious, reality-based human being should be distressed by these conditions.  The distress is a message.  It is like your hand burning on a hot stove.  The feeling of pain tells you to move your hand.  This prevents further damage.  If you just rationalize or drug that sensation away, there is no telling how bad you’ll end up.  

The painful thing is that we live in a society where many hands are currently burning.  The stove is on high, so to speak, on a massive scale.  The medical model solution is to blame and ‘treat’ (drugs, CBT, electroshock), the victims when they cry out too loud and make others uncomfortable.  We lock them up, silo them away – and not for their own sake I would argue.  Speaking for myself, there is nothing quite as devastating as realizing that you live in a world that – despite many good intentions – has somehow gone drastically off course.  Frankly, it can be a relief to know that crisis is someone else’s job and to not have to feel so unbearably helpless. 

3.    FFamilies are not the problem here

Families have been given a bad rap in popular psychology.  For many, families are our most valued allies and supports. Even where that is not the case, the social injustices of the modern world affect families just as much as anyone. 

The fact of the matter is that life is hard on its own.  There is trauma-a-plenty to go around.  Opportunities abound for poverty, discrimination, bullying, bad grades, bad judgment, job or home loss, failure, rejection, break ups, tragedy, bankruptcy, grief, regrets, humiliation, sickness, injury, accidents, threats, rape, harassment, stalking, deception, scandal, swindles, slander, targeting, insecurity, crime, worries, disaster – it’s an endless list.  

4.   A closer look at human needs and ‘trauma’

The implications of the trauma/ human needs perspective are pressing and are vast.   They provide a widely applicable, independent framework for understanding human behavior. No pathology, no chemical imbalances, no genetic markers are needed. 

Sound unbelievable?  It’s not.  All you need is an integrated understanding of the human stress response and then to connect the dots from there.

The two nervous systems

We have two basic nervous systems:

(1)    ‘All-is-well’ (parasympathetic) for everyday routines.  This is for stuff like eating, sleeping, relaxing, small talk, hobbies, tinkering around…

and

(2)    ‘High-stakes’ (sympathetic/ ‘survival response’/ fight-flight-freeze)  This is our ‘get your butt in gear’ system.  It’s our rapid response system for things that are a big deal – essentially threats or opportunities.  This includes all kinds of stuff - both ‘good’ and ‘bad’ – where the stakes are high: 

·         Discovering a new friend, new gossip, twenty dollars or your toddler in the road

·         Taking tests, exams, someone’s wallet or advantage of a child

·         Scoring a point, contract, victory or high

·         Getting laid, married, yelled at, ripped off, assaulted or stopped by police

·         Going on first dates, adventures, job interviews or a rampage with your partner

·         Getting through performance reviews, competitions, college, police interrogations or psychiatric exams

·         Resisting temptation, peer pressure, arrest or psychiatric drugs

The high stakes system is the key

If you want to make sense of so-called ‘psychopathology’, the high stakes system is the key.  If you know what to look for, you potentially can explain all the so-called major disorders - anxiety, depression, bipolar, OCD, borderline, substance use, anti-social, addictions, dependency, paraphilias, etc.  You just need to know the person’s story, their perceived needs, and their default responses when the ‘stakes are high’. 

How the high stakes system works

The high stakes system spurs the body to initiate dramatic physical and mental changes.

On a physical level:

• Blood and resources go to the muscles (tense, achy, shaky, trembling, agitated), heart (pounding), and lungs (heavy breathing, hyperventilating, out of breath).
• Energy production (digestion, swallowing, bladder, bowel) are triaged or shut down.  This leads to things like nausea, vomiting, lump in throat, urge to urinate, incontinence, cramping, diarrhea, light-headedness.

On a mental level:

• Focus narrows to the source of concern (tunnel vision, hyperfocus, losing the forest for the trees)
• Rapid response feels urgent (hair trigger, impulsive, reactive)
• High-level thinking is largely triaged out (stammering, stuttering, losing words, mind going blank). 
• Gone are the capacities needed to think ahead, remember consequences, learn new information, weigh costs and benefits, assess impact on others, defer gratification and solve complex issues.

How high-stakes and all-is-well interact

Here is how these two systems interact:

Phase 1: Initial activation (High-stakes revs up)

1. We see (perceive, experience) a threat or opportunity

2. The high-stakes response kicks in
3. Resources shift automatically from brain (rational thought) to brawn (taking action)
4. Strong effects (fight, flight, freeze) occur.

It’s important to note that fight, flight and freeze are more like tendencies than fixed forms of expression. The effects are unique to individuals.  They represent an amalgam of personal strengths, past experiences and familiar ‘tried and true’ behaviors.  Thus, different people ‘fight, flight. freeze’ on different levels and in very different ways.

Here are some things I have done:

·      

• Physical (strike out, yell, swear, damage property, run, drink or take drugs, go limp, hide in bed)
• Emotional (rage, seethe, envy, hate, worry, dread, cower, cry, space out)
• Social (complain, humiliate, beg, apologize, withdraw),
• Intellectual (argue, distract, forget, go blank)
• Spiritually (pray, leave body, become a deity, feel empty or dead,).      

   

Phase 2: Prolonged activation (If high-stakes stays turned on)

Sometimes the high stakes circumstances go on and on…. When things stay unresolved, the high-stakes system keeps at it, with the following effects:

·         

•  Resources keep going to brawn not brain
•  Mental capabilities progressively break down
•  Bodies break down too

If concerns stay unresolved for weeks, months or even years, this can take a heavy toll.  Our brains and bodies need sleep and resources to repair, restore and learn.  If they don’t get that, we might end up:

·      

•         Physically sick, injured, exhausted, attacking
•          Emotionally despondent, erratic, raging, burned out
•       Socially withdrawing, ranting, verbally attacking, totally depending on others
•       Intellectually zoning out, disorganized, losing time or memories, missing the forest for the trees
•       Spiritually visiting other realms, hearing or seeing things, feeling worthless or empty, wanting to die. 

The possibilities are endless.  That’s just some of what has happened for me.

Phase 3: Resolution (Return to ‘all-is-well’ baseline)

To stop decline, we need to feel some resolution. We need to be able to trust that things will be ok.  Otherwise, the high-stakes system will keep doing its job – which is to stay on alert and protect us from potential danger.    

The moment things start to feel resolved, however, something magical happens.  The effect is dramatic:

•       The high-stakes response turns off
•       The all-is-well system takes over automatically
•       We are able to rest, relax, digest food, sleep
•       Our bodies replenish, our brains repair and heal
•       Extremes and intensity tend to quiet down

5.    Threatening people is dangerous

The high-stakes system it is binary and reactive.  You are either friend or foe, for me or against me.  This is not a disorder, it’s basic survival.

Imagine you are in the wild.  You catch a glimpse of something out of the corner of your eye.  Is it a bear or just a tree?  Is there a stick or a rattlesnake in the path?  The high-stakes system does not take chances.  It reacts and asks questions later. 

Whether you are police, clinician, psych tech, family member, friend or the person of concern, this is the frame of mind that leads to everyone’s worst nightmare.  But, once you understand how high-stakes works, it’s pretty clear what to do.

In high-stakes times, people trust their guts (that’s where the resources are).  Talk is cheap, roles are cheap.  It’s all in how you come across.  If the right feeling happens (respect, dignity, shared humanity, genuine caring about my concerns), then the stakes go down and all-is-well kicks in. Blood returns to the brain, along with the ability to think, communicate and heal.  We all go home tonight.

It’s also relatively easy to see the problem with coercive, confrontational approaches. A show of force tends to destroy the very rapport that could be life-saving. To be sure, risk is ever present.  But, in a very real way, the odds shift with how you play your hand. (For a sterling example of this, listen to the 911 recording involving Michael Hill, a would-be school shooter and school office worker, Antoinette Tuff, https://www.youtube.com/watch?v=1kVpipSXRKA.)

It’s also easy to see why reasoning and logic don’t usually work.  This is not a reasoning frame of mind.  Literally, the brain capacity is not there.  That doesn’t mean rational capacity is gone forever.  It just means the stakes are too high for now. 

This is good news.  It is often a solvable problem. It means that we both can get to a reasoning place if one of us can make the stakes go down. 

How to do this is the million-dollar question.  But, at core, it’s really simple.  There’s a golden rule that cuts all ways:

                            If you want to make things safer,                        start looking safer to those you want to reach. 

When you scare someone, the high-stakes nervous system literally starts pumping the blood away from their brain. The more you threaten them, the less their brain has to work with.  Thus, the less rational they physically are able to become. This is dangerous for everyone!

6.    A better nosology for behavioral health…?

So where does all this leave us?

The DSM (psychiatric) model of ‘mental disorders’

On the one hand, the DSM (Diagnostic and Statistical Manual published by American Psychiatric Association) is quite frank.  It has no opinion about the root causes of ‘disorders’; it is simply a system of classification and labels. In no small part, the DSM is also the product of insider turf wars, political compromise, industry needs and billing concerns.  Caplan, PJ (1995) They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal  (Perseus Books: www.aw.com/gb)

One noteworthy consideration for our purposes is that insurance companies pay for ‘mental disorders’ – but not to help normal people who are struggling with a difficult life.  The result is a ‘don’t ask, don’t tell’ (garbage in – garbage out) approach to assessment. Rote symptom checklists determine whether your anxiety, mood, grief, trauma, substance use, sexuality is ‘normal’ or ‘disordered.’  Real life facts, like a growing up in shelter housing getting routinely abused in the group showers, are frequently ignored as irrelevant, or not even asked about. It’s like your teacher pronouncing you ‘learning disordered’ without ever considering whether you study. 

Beyond that, even the categories themselves are questionable. Experienced clinicians disagree frequently.  Individual suicide and violence aren’t predicted much better than flipping a coin.  In 2012, concerns like these led whistleblower Paula Caplan, Ph.D., to report to the Washington Post:  "Psychiatry’s bible, the DSM, is doing more harm than good." https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html  A year later, the National Institute of Mental Health literally threw out the DSM and decided to start over.  Insel, T (Apr. 29, 2013) Transforming Diagnosis, Director’s Blog (CMS), http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

The Medical Model of ‘mental illness’

The medical model hasn’t fared much better.  Despite billions of research dollars, there is no demonstrable ‘chemical imbalance’ and no compelling genetic or biological markers.  During the past several decades of increasing ‘drug therapy’, disability rates have sky-rocketed.  Long-term outcomes and relapse rates have worsened overall. There are countless reports of drugs increasing or even creating urges to violence or suicide.  Due at least in part to treatment effects, the ‘mentally ill’ lose 15-25 years (on average!) off the normal life span.  Whitaker, RH (2010).  Anatomy of an Epidemic.  New York: Random House

The social justice model of trauma and human needs

On the other hand, when you look at trauma and its effects, a different picture arises.  Much of what has been baffling about human behavior and symptoms becomes understandable:

• Resources are seemingly scarce
• People have basic needs
• They see a threat or opportunity
• The high stakes system kicks in
• Predictable physical, mental and social effects occur.

Equally important, this is not a disorder.  High-stakes reactivity is supposed to happen in high-stakes situations.  The problem is not that people are maladaptive.  The problem is that some 90% of behavioral health service users are going without basic life necessities – things that everyone needs to live and be well. 

The impact of diversity

When you put the above factors together in varying combinations, you can pretty much cover the DSM. If you factor in the survival function of high-stakes responses, it gets even more convincing.

The wide variability of high stakes responses is not an accident.  To the contrary, our natural human diversity in times of need is a tremendous asset to our species.  When an entire community is facing a threat, this ensures that people will respond in numerous rich and creative ways. 

This promotes community resilience and survival overall.  If we all responded the same way to danger or opportunity, a single threat (predator, disease, disaster) could wipe us out.  We actually need the creative solutions that people come up with under duress to ensure our collective survival.       

On the other hand, when the stakes are more individual, the virtue of diversity can get obscured.  Only one of us – not the whole group - appears to be affected.  So, the way a person responds can look pretty strange to everyone around them.   

This explains why so-called 'mental illness' is so hard to diagnose and categorize.  We're not seeing an actual 'thing' in and of itself (e.g., depression, bipolar, panic disorder).  We're seeing the response to an actual thing – for example, feeling sick to your stomach before an important test at school. 

 At this point, you can also see the futility of trying to classify so-called ‘mental disorders.’ Just look at a group of kids before a high school math test.  They are all facing the same core stressor, but there are almost as many responses as students.  (This same scenario highlights the problem with adrugs-first approach.  Very few students will do better on the test, if say, the moment someone sees you puking, the school injects you with Zyprexa.)

So let’s take this one step further.  Imagine you are having the worst day of your life.  You have been waiting for hours, naked, hungry, cold and alone, in a barely furnished room. You have never met the doctor who shows up and claims to be here to help you. After five minutes, the doctor cuts you off, then proceeds to tell you what your problem is and what you need to do about it.  A prescription is written, given to a nurse.  Your entire fate from that point on depends on what you do next.   

There is hardly a better way to exacerbate, instead of lessen, high-stakes responses.  This is true even if you come into the system as a lucky one-in-ten with no prior trauma.  On its face, such arbitrary exercise of authority is traumatizing in and of itself.  It is unilateral, frightening, insensitive, confusing and grossly uninformed.  There is no meaningful discussion, no apparent recourse, no one on your side.  Experientially, it’s much more like being a prisoner of war than a recipient of actual care. 

This kind of ‘treatment’ causes the very ‘illnesses’ that experts claim to see.  High-stakes responses are unique and extreme by design. They make look strange to onlookers, but this is a good thing overall.  Predators/ competitors are unable to anticipate or plan for what we’ll do – which promotes both individual and species survival.

On the other hand, it’s not hard to connect the dots with common ER ‘outcomes.’  People are seen at their worst, treated badly, diagnosed based on their worst possible performance and then detained and drugged accordingly.  Needless to say, this is not a particularly fair or ‘professional’ way to assess someone’s capacity to survive safely in freedom. 

The moral of the story:

            If you want to be as safe, rational and helpful               as possible, but you’re still hanging on to disordered thinking…

STOP IT!

Treating Each Other As Human Family (in progress)

If we're going to create a world that we want to live in, we need to go beyond what we already know. We need to dream of what we want - how we want to be treated - how we want people to treat each other. Then we need to finds way to walk progressively into that dream until it becomes real for us and others - one step at a time.

To do that we have to look beyond the conventional business values that are designed to maximize profit, efficiency and material wealth.  In this paradigm, human beings and human relationships are expendible as a means to an end.  We are not inherently valuable as an end in and of ourselves. Neither are the communities we live in or the natural resources upon which we all depend to survive. 

This value system is fundamentally flawed.  It will never lead to a world in which human beings feel safe and secure - in either persons or property.  Think about it.  Who trusts Wall Street to act in the interests of communities at large?  

To the contrary, modern business has evolved largely to take advantage of - even exploit - human needs and vulnerabilities. Its priority is not to advance community well-being or development.  It is headed in the opposite direction of securing private interests irrespective of the needs of the public at large. 

We also need to get beyond the liability oriented legal system.  The fact of the matter is that lawyers and the court system are ill-qualified to set the standards for how human beings treat each other to lawyers and the court system.  In the first place, the legal system has evolved in an effort to protect people from the worst of human nature - and it does a fairly unsatisfactory job at that.  Even more pointedly, who consults their lawyer to improve their relational satisfaction? 

Suffice it to say, we need to forge some new ground.  We need to develop a new ethic of human relations.  We need to go beyond the standards set by business and courts. We must get beyond the dominant culture attitudes that define and limit our value as human beings.  There is more - much much more - to human existence than our capacity to compete in the business world or to attract a mate who can.  

We must stop letting ourselves - and our value - be defined in these terms. No less important, we must stop letting healthcare and mental health professionals pathologize us for these so-called failings.  

These are not failings.  The resilience and creativity of human kind is linked to our diversity.  Collectively, as a species, we possess widely varied capacities, values, priorities, beliefs, attitudes, sensations,  - even mental states and frames of mind. Not all of these capacities work well in the marketplace. Much of what is makes life worth living is not quantifiable. Even worse, when you try to sell this kind of thing (e.g., love and caring and loyalty),  you lose its essential quality or degrade it beyond measure.  

We have not even begun to mine the potential riches among us.  We need to start.  Right now.  Because every single one of them has a rightful place.  Every single one of us has a valued contribution to make.  

This is a space where we can do that.  This is about community. Here, we offer our humanity. Our ethic is to honor human each other as human beings.  We do our best to create a relationships and world that feels like human family and advances rights. 

For us there no higher law. We acknowledge nothing that conflicts with this. 

How We've Decided to Treat Each Other at the Virtual Drop In/ Respite

Some Core Principles 

We are trying something new here.  On the one hand, we offer support, respite and drop in space for diverse mental states, experiences and frames of mind.  On the other hand, we are not about health care or medical services.

The above statement is not intended as a disclaimer.  It simply is not our value.

This space is about community.  Here, we offer our humanity.  Our ethic is to honor human rights. For us there no higher law.  We acknowledge nothing that conflicts with this.  

1. Human family

We aspire to create a group that feels and acts like human family.  This is our birthright as human beings.  We share responsibility to make this birthright a reality.  The quality of our community depends upon our efforts to appreciate this principle. 

2. Inherent dignity

Before we know a thing about each other, we already know something about each other. Every one of us has worth.  Every one of us has something worthy of offering.  We will find it if we look for it.  We share that obligation.

3. Rights

Like the old adage, 'good fences make good neighbors', rights are essential to human relationships. 

They protect us in two ways. 

• Some rights say "keep out.'  They patrol boundaries and deny entry to things that could damage health or growth.  Such rights say to us both: Your right to dominate ends where my personhood begins. 

• Other rights strive to bring in or keep in. These rights are about opening channels, or protecting access, to needed resources.  These rights recognize that there are certain things that all of us need in order to live, feel and be well. 

4. Reason

We are all endowed with reason and conscience.  Reason means we have the ability to appreciate cause and effect. We can learn from the consequences of our actions.  We can make sense of experiences.  The implication of this is important: We act in ways that make sense to us, based on our experiences.  This counsels us to judge less and listen more. 

5. Conscience

Conscience is what makes us more than robots. Conscience is about our capacity to care.  How things affect us - and how we affect others - matters to us. Equally important, we care about some things more than others. We express different levels of caring through the choices we make. 

6. Reason-conscience interaction. 

If we put them together, the principles of reason and conscience can teach us about ourselves and each other. Reason asks us to look for why something makes sense.  It helps us connect what happened before with what is happening now.  Conscience helps us to see choices in terms of our values.  It helps us to ask, not only 'why did I pick that?', but also 'what does my picking tell me about me?'  

Viewed through this bifocal lens of reason and conscience, every thought, feeling and action provides a clue to understanding human experience.  

Deeper Potential

On the surface, these are simple concepts.  But if you unpack them, they hold a world of potential. The implications are, truly, vast and revolutionary:

• The most important stuff we offer each other doesn’t cost a nickel. 
• There is no higher law. 
• No profession can license this. 
• No corporation can patent, bottle or sell this. 
• No Government can withdraw our funding. 
• It exists if we create it. 
• We can never afford to ignore it.
• We are always on the hook to live it.

Welcome to the human family.  There is no other.

Getting Beyond Shouting Each Other Down and Shutting Each Other Out

Principles for Developing an Effective, Intersectional C/S/X Movement [draft, in progress, comments welcome]

Part I. The Necessity of Addressing Multiple Truths

A. Shouting Each Other Down

As mad people, our hallmark is that...

• We have diverse beliefs and perspectives among us
• We tend to believe strongly what we believe
• We tend to believe strongly in our right to believe it

Think about it.  If this weren't the case - if we didn't care deeply about our truths, we would never get locked up in the first place.  Instead, the first time someone said to us, "If you don't change your tune and start behaving rationally we are going to lock you up", our truth would go out the window.

In other words, the reason we that many of us judged crazy in the first place is - for many of us - a matter of core values and personal principle.  We have truths - feelings, intuitions, thoughts, beliefs about the nature of reality - that are

1. unique (or at least non-'normative');
2. deeply important or meaningful at the personal level; and
3. not negotiable to some basic part of the 'primal being' that controls how we express ourselves   

 This effectively answers the Rodney King question: Why can’t we all get along?  

It also begs the question:

     How can we build a movement when there is: 

1. So much that we see differently; and 
2. So much passion around the differences that we do have?  

Implications/ Challenges:

 

1. Pragmatic:  

If we continue to simply attack each other - rather than learn how to build on the strengths of our differences - we will kill our energy and effectiveness for change.  We will also lose the benefits of our naturally diverse humanity  - including the added capacity and learning potential that this represents.

2. Political/ Historical: 

Psychiatric oppression is all about conflict and what happens when worldviews collide. Dominant culture ‘truths’ - like medical model psychiatry - are accorded a status of power, privilege and social validity.  In contrast, truths that are considered unique to individuals and our lived (‘personal’) experiences are dismissed or degraded.


Equally important, the dominant paradigm privileges certain social roles - like psychiatrists - to evaluate and overrule the truths of others.  In the medical model paradigm, doctors hold the ultimate power to determine mental truth.  Everyone else -- including identified ‘patients’, natural supports (friends, family, neighbors, co-workers) and other professional disciplines (psychologists, social workers, psych techs, police, judges, teachers) -- is expected to defer to the presumption of psychiatric expertise.  This is true even if the psychiatrist has only an hour (often much less!) experience with us on the worst day of our lives and others have known us for a life time.

In this paradigm, when disagreements arise, the normative cultural values win.  So does the person with social role that tops the cultural privilege hierarchy. As a practical matter, this means that the conversation stops the moment someone with relative social power - like family, police or a mental health provider - feels uncomfortable.  At that point, the privileged actor assumes their ‘rightful’ position as the ‘higher authority’ on true versus false.  Backed by normative privilege, the usual outcome is that their butt ends up on the protected side of the syringe, totally covered.

In contrast, the individual truth has no such comfort.  Having conflicted with socially privileged viewpoints or roles, its ass ends up on the pointy side of syringe - totally exposed and about to be needled.

The effect of these power dynamics on authentic human relationship is devastating.  Few people dare speak truth to power, and when we do, it is at our peril.  The rest of society sees what happens to us, and becomes even more compliant.  Allegiance is pledged with great fanfare to the dominant culture viewpoints. People hide or change their natural diversity in order to fit in.  Disagreement goes underground and is avoided or minimized whenever possible.

All of this gives the appearance uniformity and agreement.  Human relations look pretty and go smoothly on the surface. This in turn makes even minor questioning seem aberrational and alarming. Dissenters are met with harsh judgment and given reason to regret it.

The resulting dynamic is self-reinforcing for those in privileged roles.  Things routinely go their way. Aggressive enforcement of social norms is protected and rewarded. Contradictions are suppressed and easily disposed of. All of this reinforces their assumption that the dominant viewpoint is good, right and producing the best world possible.

In this social climate, honest exploration of human diversity in thought, feeling, expression and action becomes all but impossible.

To create real social change, we have to stop this vicious cycle. We need to balance the power between individual and social truth. We also need to challenge the cultural attitudes that privilege some actors and marginalize others based on demographic and/ or ideologic alliances.  This requires finding a principled alternative for understanding and approaching human differences.

Credits:  

• This analysis draws heavily on the work of Shery Mead and Chris Hansen of Intentional Peer Support, intentionalpeersupport.org, and Tina Minkowitz of the Center for Users and Survivors of Psychiatry, chrusp,org.  Taken together, their work articulates the lion's share of the relational and human rights principles we rely on here. 

B. Shutting Each Other Out

Some new vocabulary:

• Appropriation of Voice

At all levels of society, including business, academics, organizations and families, those in positions of relative social power seem to believe they have the right to speak on behalf of those who have less of it.  Everywhere we look, those at the top of conventional power hierarchies are freely appropriating the voices of those lower on the totem pole.  They are speaking to and for the needs of others.  They are deciding what is good for us and our families.  They are deciding what policies and positions are necessary, good and right for all sorts of us without ever having to be troubled to talk people of our sort.   They are deciding, literally, the directions and fate of organizations in which hundreds, thousands, even millions of us have invested our efforts, trust or lives without one wit of socially enforceable obligation to to even give a rip.  

• Confabulated Representation

The decisions toppers make affect us every day and in every way.  Their whims affect - and radically alter - the quality of our jobs, well-being, housing, healthcare, food, environment, relationships - everything we hold dear.  Yet, under the topper rule of “toppers rule’ , toppers are largely free to do this without ever having spoken a word to us, without acknowledging our opinions as relevant, without knowing - or caring - that we exist.   To the extent that toppers claim to be speaking on our behalf in these circumstances, their actions have more in common with fraud than genuine social service.

• Iatrogentic Leadership

The toppers rule is great for toppers -- but often devastating for everyone else.  The result is to amplify the voice, legitimacy and power that toppers already have, while effecting political and social death for the sorry-lotted rest of us.  This perpetuates - rather than alleviates- the oppression of those who are so ‘led’.

• Organizational Guardianship

As ‘toppees’, we are considered subject to the topper’s lawfully-permitted hierarchical rule.  Vast realms of human concern are left to their discretion.  Apart from bare minimums, like paychecks, contracts or physical violence, toppees have virtually no say, no voice, no right to complain, no lawful recourse.  The social assumption is that toppers know best - no matter how outrageously we are disregarded, degraded or damaged.

While not recognised as such in many contexts, the conventionally accepted ‘toppers rule’ has much in common with the historic practice of 'guardianship’  in mental health.  In both practices, those with social power are deemed entitled to ‘substitute’ their judgment for those with less power.  The practical effect - as many have noted - is the political and social death of those represented.

Where Have All Our Voices Gone? 

Whether their funding source is public, philanthropic or for-profit, mental health organizations represent that that their purpose is to improve the lives of those who have been psychiatrically labeled.  Yet, those of us who have been psychiatrically labeled are rarely, if ever, consulted about how funds intended for our benefit should be used.

To the contrary, decisions typically are made by a privileged few (managers, directors, policymakers, clinicians) who determine - about us without us - what we need and how to get it.  This thwarts our access to the respect, dignity, meaningful voice and active participation that are essential to the personal and political self-determination of any oppressed people.

Repeating the trauma of psychiatry

The de facto practice of organizational guardianship re-enacts the essential trauma and oppression that mad people have experienced at the hands of psychiatry since its inception. The essential dynamic is one wherein a few designated 'experts' who 'know' are deemed entitled to substitute their judgment of what is in our 'best interests.'

It comes from the mistaken assumption that some people ‘know’ better than others what is ‘good’ for them.  Yet, the very social characteristics that qualify people as ‘the ones who know best’ are things like family standing, position in society, employment roles and academic credentials. These roles - and the people in them - historically have been part of the problem, not the solution, in our lives.

They were part of the existing power structure when our oppression started, yet they did nothing to stop it and may have actively used it to strip our rights.

Moreover, the same social roles that those in higher roles (toppers) now say entitle them to decide what is good for those in lesser roles (toppees) arguably are what created the social structures that oppress so many of us in the first place.  We think the conventional practice of classifying people into hierarchical categories of social worth is a big part of the problem.  It both reifies the construct of a social underclass, and validates the relative social privilege of topper roles vis-a-vis toppee roles.

These dynamics reinforce the social attitudes that perpetuate the continued vulnerability to labelling and marginalization by ‘toppers’ of ‘toppees.’

Peer-on-peer oppression and opportunism

Many people see paid peer roles and so-called peer-run organizations as signs of progress.  However, very few of these organizations actually represent the interests of the larger peer communities the claim to serve.  For the most part, these organizations continue to make the same hierarchical role distinctions - paid/ unpaid/ manager/ worker/ volunteer/ recipient - as traditional organizations.

Many peer organizations also adopt and perpetuate the same dominant culture attitudes and practices that inspired the mad rights movement in the first place. Hence, in far too many cases, the major difference between peer and non-peer services is that it is us doing it to us - and then calling it social progress because we got paid to do it.

To many of us, however, this does not look like social progress.  We suspect, in actuality, it is more akin to the psychiatric equivalent of plantation overseers and house slaves.  While some may disagree, to our way of thinking, this is about the system finding a way perpetuate the same social order for less money -- by using our people to run it and then laughing at us all the way to the bank.

It is also about needing to make a living and support a family and having no better options.  It is about socio-economic conditions that make us so desperate that we stoop to oppressing each other in return for the proverbial pat on the head and a piece of institution-shaped pie.

Appropriation of Opportunity in the Name of Advocacy 

This guardianship dynamic is even more painful when it manifests in the so-called advocacy organizations that purport to work on our behalf.  These people have jobs because mad people paid the price.  We advocated tirelessly for countless years without compensation to bring our oppression to social awareness.

Now so-called advocates make a living from our cause. They say they are working for us - that they represent us and our best interests. They give away our rights - and decide what we can live with.

Yet, they make no meaningful effort to reach out to us, engage us, ask what we want or what would make our lives better.  They consider it our responsibility to seek them out if we want to have a voice with them on our own issues.

In what other business could you operate this way?  It’s like:  You hear a rumor that Joe Peer needs help. So you write up a grant, get Uncle Sam to fund it, do what you feel like doing, collect a paycheck every week and then tell everybody what a sad case Joe Peer is and how much he loves what you are doing for him.  Uncle Sam keeps the paychecks coming.  No one knows you’ve never even met Joe Peer. This is self-promotion not advocacy.  It’s also fraud.  

Do You Have Authority to Exercise Authority? 

The Universal Declaration of Human Rights makes clear that authority for governance derives from the governed.  The Convention on the Rights of Persons With Disabilities expressly rejects a ‘guardianship’ approach to governance. (Art. 12).  Thus, appointed leaders may not simply substitute their judgment for that of the constituency they claim to serve.  Rather, they may only represent individuals who have requested their assistance.  Moreover, the scope of their authority is to ascertain and support the 'rights, will and preferences' of any such persons.

Let’s be clear here: So far as a lot of us are concerned:  We didn’t ask you. You don’t know us.  You make your living catering to the system that oppresses us. You are abusing your power and calling it ‘help’. If don’t see how that’s happening or your part in it, you’ve just proved our point. 

Part II: A Human Rights Framework for Finding Common Ground Across Multiple Truths

Historically and intuitively psychiatric survivors have drawn on human rights principles to validate and articulate our concerns in  the dominant culture.  We can draw on this same framework - and it's profound, radical, socially transformative implications - to overcome the challenges that exist among us and to find common ground for connecting across them.

Part A: Core Principles for Negotiating Multiple Truths (from the Universal Declaration of Human Rights [UDHR] of 1948): 

• We are all equal in dignity and rights.  (Art. 1)

Dignity means that we all have inherent worth and value.  It further hope for mutuality and developing shared vision. In effect, dignity says, “By virtue of the fact that we are both human beings, I trust that there is something about each other that we will find we both value.”

Respect for human rights means that we all share in the birthright of cultural regard - simply by the fact of being human.  In this sense, rights are not essentially an individual concept, but rather something we hold in trust for each other.

At core, rights are really about human needs.  They reflect the consensus of the human community that some needs are so important that no one does well without them.

• We are endowed with reason and conscience.  (Art. 1) 

Reason means we are all capable of learning from our experiences.  We can recognize cause and effect.  We can use what we already know to make new connections that lead to new awareness.
Conscience means that, by nature, human beings are caring animals. We can get beyond self-interest and take into account how our actions affect others.  We are inspired by values - and prioritize some over others - based on our lived experiences.

• We are members of a human family and should treat each other that way (Art. 1)

Family is what we want to come home to.   It means having each other’s backs instead of stabbing someone in the back.  As human family, we support each other to access to the material, social and developmental resources that everyone needs to live and be well.  

According the UDHR, recognizing these principles is key. They represent our hope for foundation of freedom, justice and peace in the world.   They can help us create a world that this is free from fear and want. (Preamble.)

Bringing about this new world order is the highest aspiration of humankind. We are all charged with a non-delegable responsibility to become aware of these principles, promote them, and to work for a world where they are respected and realized by everyone everywhere. (Preamble, Art. 29)

Part B: Core Tasks for Finding Common Ground: 

• Meeting each other as human beings instead of from positions of power and privilege

This necessitates moving beyond thinking of 'peer' status as something that derives from mental health or organizational roles.  Rather, our essential 'peerness' is a function of our shared humanity, our common birthright as human beings, and the common needs, challenges and aspirations this implies.

The long-term implications of failing to do negotiate through our differences are dramatic and dire.
As human beings, we have inherited a 10,000 year legacy of intergenerational trauma, including literally centuries cultural and relational wounding from the dynamics of predator-prey.

Thus, our collective need for healing and transformation is vast.  The alternative to this is to continue on our current course of traumatic reactivity.  If allowed to continue uninterrupted, the latter is our ticket to mutually assured destruction - as a species and a planet.

• Finding ways to communicate and integrate our multiple truths

The alternative to mutually assured destruction is finding a way to make our differences work for us instead of against us. Our differences stem from our natural diversity and contribute to our robustness as a species.  Our hope of doing this necessitates learning to listen for gifts and strengths - instead of threats and faults.  It also entails learning to get beyond factual details and listen for the core meanings and values that we are trying to get across to each other.

The idea of listening for meanings (instead of 'just the facts maam') comes out of Hearing Voices Movement.  They insist that voices are real and must be taken seriously.  At a minimum, there are two important implications of this:

1. Voices (people) wouldn’t be bothering to communicate unless there was something they a lot cared about. This is therefore is worth others of goodwill and conscience paying attention to.
2. Moreover, the bigger the feelings, the more intense the reaction, the more deeply (we should assume) that voices (people) care about being heard.  This is therefore is worth others of goodwill and conscience holding in increasingly high regard, versus writing off as too biased, unbalanced or 'crazy'.    

Beyond this, there are pragmatic reasons to learn to listen for meanings and metaphor.  Moreover, this is true for a broad variety of human conversations, not just 'mad' ones.

Learning to listen for meanings and metaphor helps us to find shared values and interests that we can build on to bridge human differences.  From there, we can explore options and resources for getting where we want to go.  In the end, these understandings will support us to develop a shared vision that includes what is most important to each person; and doesn't include anything that someone just can’t live with.

To do this, however, we have to stay in conversation long enough to get to really know each other. There will probably be a lot of discomfort and uncertainty along the way.   When this comes up, it can help if we focus on trying to really ‘see’ where the other person is coming from,  We also can focus on listening to understand instead of just trying to make our point. (Shery Mead, Chris Hansen, Intentional Peer Support).

The critical meta-task in all of this (from Shery Mead of Intentional Peer Support)  is learning to continually hold the following question in mind as we’re listening and sharing:  How is what I am saying, thinking or doing here contributing to the quality of the relationship that I would like to build?

Resourcing our Development: 

There are several useful approaches/ human resources available to us for learning how to do this, including:

• Intentional Peer Support (Shery Mead, Chris Hansen, Steven Morgan, Eva Dech), 
• eCPR (Dan Fisher, Lauren Spiro, Ann Rider, Oryx Cohen) 
• Hearing Voices Movement (Intervoice, US Hearing Voices Network, Western Mass RLC)
• Icarus Project (Sasha DeBrul, Jacks Ashley McNamara, Will Hall)
• Non-Violent Communication (Marshall Rosenberg, Phil Shulman) 
• Asset Based Community Development (Eva Dech), 
• Appreciative Inquiry (who knows this well?).  

Part C: Core Strategies for Finding Common Ground 

Some principles we could stand on together:

1. We speak for ourselves.
2. The expertise we value is lived experience.  
3. The value of experience by training (about populations and norms - developed about people without them - is determined by end users.  End users are privileged to decide, on a case by case basis, whether and to what extent so-called normative data applies and/ or make sense to them in the context of their real lives. 
4. The role of allies and supporters is to facilitate our quest - individually and collectively - for self-determination. 
• We don’t expect others to be our servants.  
• But they also do not get to pressure us, decide for us or to substitute their vision or experience for ours. 
• Rather, the intention is to listen and learn. Should others choose, they can also use their power to open doors - when that is the way we decide we want to go. 
5. The authority of those in positions of trust derives from the people they claim to represent.  
6. To be valid, representation requires:
• making every effort to find and engage every single person who falls within the constituency that is claimed to be represented.  
• consulting all of us directly.
• getting to know us well enough to understand what we care about as human beings
• accurately representing our diverse needs, values and viewpoints on a public and policy level
• actively working to incorporate the core essence of what we care about into every negotiation that affects our wellbeing, whether directly or indirectly 
• making absolutely clear who you were not able to reach - or reach agreement with 
• being extremely clear that your representation does not extend to those particular people or groups. 

Credits:  

• Thank you Tina Minkowitz, Pat Risser, Eva Dech, Dan Hazen, Lauren Tenney, Darby Penney, George Ebert and so many others for insisting that the core issues in our movement are matters of human rights, not matters of medicine, and can and should be conceptualized as such.  
• Thank you Shery Mead, Chris Hansen and Intentional Peer Support for proposing a clear, practical, principled relational vision of how we can do this. 

Part III: Exploring and Finding A Common Vision

Some questions we could ask each other:

1. What do you care about most?
2. What social attitudes, practices, policies, or barriers do you personally find most distressing or destructive to your well being?
3. What social changes (attitudes, practices, policies, access to resources) would, if realized,  most contribute to your personal well-being? 
4. In your lived experience, what contributes most distress or crisis for you?
5. What relational qualities of human beings are most harmful or damaging?
6. What other kinds of issues most contribute to or exacerbate distress or crisis for you?
7. What helps the most when you are vulnerable on in distress?  
8. What relational qualities that human beings have or could offer are most important? 
9. What other kinds of support do or could help the most in trying to move forward?

Credits:  

• Mary Ellen Copeland, Wellness Recovery Action Planning,  http://mentalhealthrecovery.com/
• Shery Mead/ Chris Hansen, Intentional Peer Support (Focus Plan), intentionalpeersupport.org

Part IV: Developing a Plan & Making It Real

Some questions we could ask each other:

1. What could we do - individually and collectively - to move toward this vision between now and when we get together next year? 
2. What do you personally feel most passionate about trying to achieve between now and when we meet again next year?
3. How, specifically, do you want to work on this? 
• What tasks are you willing to do?
• How much time do you have for this work & how often?
• Where will you do it?
• With whom?
• What first is your first step?
• When will you take it?
4. What support do you need from each others to do this work?
• What gifts, strengths, know-how, resources do you need access to? 
• Who is willing to help? 
• How much can they help?
• How can you get / stay in touch with them? 
5. How will we stay connected and keep accountable to our vision during the upcoming year?
• What ways do you like to connect/ work on stuff? 
• How much time do you have for connecting around this work & how often?
• What are gifts, strengths, know-how, access to resources are you willing/ able to contribute to stuff other people are working on?
• What a
• venues or social media do you most like to use?
• What do you want others to do if you disappear or seem to go off track?
• Who do you want to hear from and what should they say or do?

Credits:  

• Mary Ellen Copeland, Wellness Recovery Action Planning,  http://mentalhealthrecovery.com/
• Shery Mead/ Chris Hansen, Intentional Peer Support (Focus Plan), intentionalpeersupport.org

About This Document:

This document came together as a result of conversations between: Lauren Tenney (laurentenney@aol.com); Eva Dech (evadech@gmail.com); and Sarah Knutson (skknut@gmail.com).  It expresses our lived experience and hopes for the future. With regard to lived experience, this includes not only our painful experiences resulting dominant culture oppression, but also from the ways our movement has reflected the dominant culture and perpetuated the same kinds of harmful dynamics around power and privilege that led to our labeling by psychiatry in the first place.  Our hope here is to state our concerns, raise consciousness, generate discussion and find a principled way forward to a world that is worthy of our hearts and minds, and that, potentially, we all might want to live in.  

Mental Health Consumer Protection Legislation - [Your State Here]

(in progress, still very drafty, comments welcomed)

Preface

Recipients of both voluntary and involuntary mental health services have long been the subject of discrimination and social maltreatment. The history of this in the United States is well documented and includes over 50 years of strategic eugenics on political and social levels. This historic context of discrimination has allowed egregious harms to be perpetuated against recipients of mental health services in the past. Such harms continue to this day, and urgently require effective, corrective legislative action to remediate.

For this reason, those receiving (or at risk of receiving) mental health care deserve legal status under American law as a protected class. Any legislation seeking to curtail the rights of class members should be treated with strict scrutiny. In addition, protective legislation is needed in order curtail current abuses and prevent further harm.

Part 1: A Consumer Protection Bill Requiring Informed Consent and Truthful Advertising in the Prescription of Psychoactive Medications

Rationale

The most urgent current abuse in need of corrective legislation is happening with regard to the prescription of psychoactive medications as a treatment for what is currently being defined as ‘serious mental illness’ (hereafter ‘SMI’).  In Anatomy of an Epidemic, Pulitzer Prize finalist Robert Whitaker explored how the number of people disabled by SMI tripled over the past two decades. Whitaker’s work received wide acclaim for its investigative journalism, including the 2010 Book Award from the Investigative Reporters and Editors (INA).  The present reality, documented by Whitaker, includes the following:

• Since the advent of psychoactive medications, disability rates for ‘SMI’ have more than tripled in the United States.
• About 80 percent of people who are prescribed psychoactive medications for an ‘SMI’ do worse long-term rather than better.  
• Psychoactive medications are highly toxic and result in permanent disability rates 90% or more when taken as directed.  
• When taken as directed, psychoactive medications cause people to die (on average!) 25 years earlier than their non-complaint counterparts.  
• Before the advent of these medication, as many as 2/3 of those diagnosed with ‘SMI’ would return to acceptable levels of social functioning.  
• In Third World countries where people do not have access to these medications, as many as 2/3 of those diagnosed with ‘SMI’ also recover an acceptable level of functioning.  
• The most successful program in the Western world for addressing schizophrenia uses psychoactive medications only about 20% of the time and then only as a last resort after non-medication interventions.  The program, Open Dialogue, holds mental health providers responsible to provide early, intensive and comprehensive support to families upon receiving notice that a family member is distressed.  Over 2-3 decades of consistent community-based practice, Open Dialogue has virtually eliminated schizophrenia in Finland. 
• Numerous other effective, non-medical-model approaches for dealing with mental distress exist. Yet, due to funding, advertising and wide scale co-optation of the medical research establishment by the pharmaceutical industry, vulnerable citizens and their families are routinely being told by well-meaning healthcare providers that the only available treatment for their distressing mental status are highly toxic disabling psychoactive medications.  
• This is a bald distortion of the evidence and requires immediate and aggressive consumer protection legislation to protect the public interests.  

Following is an analogy.   Imagine you purchase a lawn mower that the manufacturer knew, when used as directed, would:

• Leave 80 percent of lawns looking worse than before they were mowed.
• Over time, rendered unsalvageable over 90% of the yards it was used on.
• Decrease the average person’s property value by  1/3.

Who would stand for this?  

As incomprehensible as it seems, this is the state of modern psychopharmacology documented by Whitaker in Anatomy of an Epidemic.  As a result of active collusion between the pharmaceutical industry, psychiatry and the medical research establishment, there is an astronomic market for a dangerous, ineffective, disabling product.  The public relations and marketing have been used so effectively to obscure the human carnage that someday we’ll look back fondly on the tobacco industry think it was selling life savers by comparison.  

As a result, protecting the public health and welfare now requires immediate, aggressive corrective action.  Such action is necessary in order to set the record straight and to prevent further, irreparable damage to innumerable  individuals and families who have already – or might still become - the unwitting victims of this deliberate, fraudulent marketing scam.  

Text of Legislation

Legislative Intent:

1. To protect public health and welfare from intentionally distorted information about the efficacy of  psychoactive medications in addressing mental states that distres self or others.
2. To protect public health and welfare from dangerous, disabling products that have been popularized as a ‘treatment’ for mental states that distress self or others.  
3. To correct the widespread public misconception that psychoactive medications are the only available treatment for mental or psychiatric challenges
4. To ensure that citizens who are considering taking psychoactive medications are adequately informed of the known and well-established risks

Required Protections:

Any practitioner who proposes to prescribe psychoactive medications to address a mental state that distresses self or others must:

• provide the following warning / acknowledgement; and 
• obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before prescribing such medication: 

Required Warning

1. There is no proven genetic or biological cause of ‘mental illness.’
2. Psychiatric medications do not correct any known biochemical imbalances in the brain.  After several decades of research, scientist still to do not know how they actually work. 
3. Currently, there are very few current studies involving the efficacy of psychoactive medications that are not funded by Pharma and/ or conducted by Pharma-funded researchers. 
4. The Pharma studies that do exist show that, at best, some people benefit from psychoactive medications. However, this is often at the cost of life-limiting, disabling or life-threatening ‘side effects’. 
5. The non-Pharma studies that do exist suggest the following:
• About 80% of people will be better off if they are never exposed to psychiatric medications;
• People in Third world countries where medications are not widely available have a much higher long-term recovery rate from schizophrenia and bipolar disorder (33- 66% recovery) than people in first world countries where medications are routinely prescribed (only 8% recovery)
• Recovery rates in the United States in the 1940s-1950s, before psychoactive medications were widely prescribed, were vastly higher for bipolar disorder and schizophrenia (33-66% recovery).  Today, with psychoactive medications are widely in use, recovery rates are only 8%.
• People with serious mental health conditions who are medication compliant do worse and die sooner (25 years sooner!) that those who are non-compliant.
• Many psychoactive medications have serious (sometimes irreversible) effects that may result in reduced physical, emotional or cognitive functioning, permanent disability and even death.   
• Many psychoactive medications produce short-term, immediate relief from symptoms.  However, this should be weighed carefully because long-term prognosis often worsens as a result (including the likelihood of more frequent and more severe relapses).  
• Those with the best recovery rates from serious mental illness are the people who are never exposed to psychiatric medications.
6. Significant evidence now suggests that Pharma and the American Psychiatric Association have been materially misrepresenting the effectiveness of psychiatric medications for their own financial/ professional gain at great cost to both individuals, families and the public at large.
7. Many people have successfully recovered from severe psychiatric conditions without the use of psychiatric medications.  
8. Many people believe that finding alternatives to the use of psychiatric medications either enhanced or enabled their recovery.  

Part 2. A Consumer Protection Bill Requiring Accurate Assessment and Diagnosis in Mental Health and Psychiatric Settings

Rationale:

The National Council for Behavioral Healthcare is a national trade organization which represents behavioral health organizations nationwide.  In 2011, the National Council ‘broke the silence’ on the impact of trauma in behavioral healthcare.  In a special publication devoted entirely to the issue of trauma, National Council leadership called for behavioral health providers in mental health, substance use, criminal justice and public housing settings to recognize and respond to role of trauma in behavioral health.   In this publication, the National Council recognized that more than 90 percent of clients the public mental health system are trauma survivors.  Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote:  “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.”  Many also have suffered serious neglect and deprivation related to basic human needs like food, shelter and protection from the elements. 

The National Council also recognizes that trauma survivors have rights.  Significantly, these rights are based on our status as human beings and entitle us to effective, trauma-sensitive treatment and care. http://www.thenationalcouncil.org/wp-content/uploads/2012/11/Survivor-Bill-of-Rights.pdf.  Just as important, according to the National Council, universal trauma-informed care is a do-able, effective, cost-saving response to public behavioral healthcare needs. 

Accordingly:  Mental health providers can and should be required to uniformly screen for trauma and provide trauma –informed treatment.  There is no longer any excuse for providers – in Vermont or elsewhere – for offering citizens anything less than complete and competent trauma-informed responses to the behavioral health needs of its citizens.  The premiere organization representing behavioral health providers nationwide has spoken.  Trauma-informed care is the most effective standard of care for behavior health – both from a results and cost-containment standpoint.  There is no reason not to do it.  It is good for everyone.

Here is an analogy:

Imagine you went to your doctor with a common cold.  (Many people think that trauma is the ‘common cold’ of behavioral healthcare).  The reality is that most common colds get better with time even if untreated by conventional medicine.  Your symptoms including a cough, congestion and some wheezing,, which are also symptoms of lung cancer.  

The doctor you went to was a sincere, conscientious competent practitioner.  He read the medical journals and regularly attended meetings of his professional society.  

Unbeknownst to your doctor, however, his professional association had started making a lot of money by promoting cancer drugs and thus was no longer a trustworthy source of information. Consequently, by the time you presented with your symptoms,  everyone was convinced there was a ‘lung cancer epidemic.’  Moreover, aggressive, early high-dose cancer drug intervention had  become the standard of care.  The clear message from the professional licensing and medical research communities was that any medical provider who did otherwise was committing malpractice.  To the contrary, the paradigm shift had progressed so far that many professionals questioned whether the common cold had ‘really’ ever existed.  At the very least, nearly everyone was confident that the common cold was not the cause of the coughing, wheezing and congestion they were seeing today.    

As a result, your doctor never bothered to assess you for a common cold and proceeded to treat you as if you had cancer.  You got worse – because the drugs are highly toxic.  You eventually died (25 years before you would have!) from the effects of the drug.   At that point, people said how sad it was that there is a lung cancer epidemic and that you were its latest victim.  No one ever knew, because no one ever assessed you in the first place, that you had a common cold that probably would have gotten better with time if they had just left you alone.  All you really needed was a bit of support to rest and heal. 

Sound outrageous?  It is.  Yet, this kind of thing is happening in the mental health system every day.  The sad fact is that roughly 90% of those who present in clinical settings are trauma survivors.  Yet, they are being diagnosed and treated as if they have a serious mental illness of genetic or biological origin.  They are further being told that their only treatment option is to take highly toxic pharmaceuticals, which:

• make 80% of those who take them worse instead of better; 
• lead to permanent disability in over 90% of those diagnosed with SMI; and 
• cause those who take them to die, on average, 25 years earlier that their untreated cohorts.   

The travesty this is wreaking on individuals, families and communities in Vermont is unforgivable. It is highly likely that, every day, thousands of Vermonters are being treated with highly toxic drugs for presumed illnesses that they do not have.  The damage being done is potentially huge and almost entirely preventable through proper assessment and treatment.  Accordingly, immediate, corrective action is now indicated in order to protect the public health and welfare from further damage, as well as to seek remedy the damage that has already been done to unknowing, unwitting citizens. 

Text of Legislation 

Legislative Intent: 

1. To protect public health and welfare from ineffective, incomplete and harmful assessment, diagnosis and treatment involving mental states that distress self or others. 
2. To correct the widespread public misconception that all distressing mental states are caused by genetic defects or brain malfunction. 
3. To promote the health and welfare of individuals, families and communities in Vermont by ensuring that pre-existing trauma is assessed, diagnosed and responded to in trauma-informed, culturally-sensitive ways 
4. To promote public health and welfare by ensuring that systems of care are equipped to offer culturally-sensitive, trauma-informed responses to every Vermont citizen experiencing a mental state that distresses to self or others. 
5. To ensure that citizens seeking mental health services are accurately informed about, and screened for, the impact of trauma on their biopsychosocial well-being. 
6. To ensure that actual sources of traumatic distress for Vermonters are properly acknowledged and addressed by mental health professionals. 
7. To counter the widespread misuse of medication-only approaches that continue to ‘blame the victim’ and pathologize Vermonters’ legitimate responses to distressing life circumstances and events.

Part A: Requirement of Truth in Advertising and Informed Consent Related to Mental Health Assessment and Diagnosis

Required Protections:

Before assessing, diagnosing or treating any Vermont citizen for a mental state that distresses self or others, any behavioral healthcare practitioner in Vermont must:

• provide the following warning / acknowledgement; and 
• obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before proceeding with such assessment, diagnosis or treatment:

Required Warning

1. There currently is no accurate means of diagnosing a mental health disorder or distinguishing one so-called ‘disorder’ from another. After decades of research, so-called experts still cannot agree. 
2. There is no known biological or genetic cause to ‘mental illness.’ To the contrary, recent advances in genetic mapping suggest that the neurological factors involved in ‘mental illness’ are even broader and more diverse than the factors involved in determining human intelligence. 
3. By far, the most common correlate of mental health system involvement is trauma. Approximately 90% of those in the public mental health system, substance use treatment or corrections settings - and more than of 90% of homeless individuals – are survivors of childhood trauma. Many others may be experiencing the after-effects of a material, emotional, physical, economic, relational or existential traumatic stressor that occurred later in life. 
4. Many of the symptoms of traumatic distress, including chronic adaptations to traumatic distress, are identical to those of serious mental conditions, including psychosis, dissociation, mood irregularities, motor/ speech/thought disturbances and suicidal/ homicidal ideation. 
5. If you have not been screened for the after-effects of distressing or traumatic life experiences, events or circumstances, your service provider must do that now. 
6. If you are suffering from the effects of traumatic distress (past or present): 
7. Your symptoms may greatly reduce when the source of your distress is addressed and/ or your sense of safety is restored. 
8. Your treatment provider should not diagnose you with a ‘mental illness’ or prescribe treatment for a ‘mental illness’ unless: 
• the source of your distress has been substantially addressed; and 
• your symptoms have not improved or remitted 
9. Psychoactive medications may provide temporary relief from symptoms while you are working to alleviate the source of your distress. However, you should weigh the risks carefully because the long-term costs may be significant and irreversible. 
10. Safe and effective alternatives to psychoactive medications exist. They include: 
• trauma-informed care, 
• Hearing Voices, 
• Open Dialogue, 
• person-centered therapy, 
• motivational interviewing, 
• family therapy, 
• cognitive behavioral therapy, 
• art or movement therapy, 
• narrative therapy, 
• Wellness Recovery Action Planning, 
• peer respite stays, 
• peer wellness centers 
• Intentional Peer Support

Part B. Requirement of Accurate, Unbiased Assessment for Pre-Existing Distress and Trauma

Required Protections:

Before assessing, diagnosing or treating any Vermont citizen for a ‘mental disorder’ as defined in the DSM/ ICD, all behavioral healthcare practitioners in Vermont must offer:

1. Proper Screening: Whenever any person presents or is presented for a mental health assessment, the following is required:

• ACES Screening upon admission 
• Comprehensive screening for current, ongoing, or previously unaddressed biopsychosocial stressors. 

2. Proper Treatment: Where ACES or biopsychosocial factors are identified:

• The admission reason for the current treatment episode shall be provisionally listed as such factor(s). 
• Such factor(s) shall be accepted for insurance purposes as the provisional diagnosis. 
• Unless and until the identified factor(s) are substantially resolved or addressed, the Initial treatment plan shall focus on: 
• Such factor(s), and 
• supporting the person to alleviate or cope with symptoms/ distress 
• The reasonable costs involved in alleviating the persons traumatic distress shall be considered legitimate medical expenses and reimbursed as such by insurance, without regard to whether such costs include ‘traditional medical services.’ 

3. Proper Diagnosis: No person shall be diagnosed with a ‘mental disorder’ within the meaning of the DSM or ICD unless and until:

• The assessments Part A.1. have been diligently conducted in good faith, properly documented in the record, reviewed with the service recipient and acknowledged in writing by both parties. 
• The service recipient has been offered a broad selection of trauma-informed interventions, including any intervention (whether medication or non-medication) that the recipient requests and could be made reasonably available with due diligence on the part of the provider or the Designated Agency in the locality where service recipient resides 
• All identified potential sources of traumatic distress have been substantially addressed; and 
• The person’s symptoms have failed to remit or materially improve. 

Part 3. Preventing Systemic Re-traumatization

Rationale:

Systemic re-traumatization is a common and serious problem in emergency rooms, healthcare settings, and when emergency responders are called in to assist in containing an emerging situation. The trauma cuts all ways and affects everyone on all levels. This includes emergency responders, service providers and service recipients. Sadly, much of this trauma is needless and avoidable.

Numerous alternatives to involuntary ‘treatment’, including medications, exist. Moreover, some psychiatric inpatient settings have reduced their use of involuntary interventions, including seclusion and restraint by over 99% after making a concerted effort at training, prevention, and non-violent implementation over a period of years.

Text of Legislation

Legislative intent:

• To protect citizens in healthcare situations from avoidable traumatization and/ or retraumatization associated with the mental healthcare intervention and treatment 
• To protect citizens in vulnerable mental states from being traumatized by the very intenventions that are intended for their benefit. 
• To make service recipients, the public, intervention teams, and health providers aware of the traumatic potential of the services that are being provided. 
• To reassure all citizens, regardless of status, that all possible steps are being taken to prevent systemic retraumatization in the name of care. 

Required Protections:

1. Staff training:

All staff whose job roles include interacting with service recipients must be trained in trauma-informed care and eCPR. Training must including annual refreshers for both modalities.

2. Person-centered Assistance:

All service recipients who are receiving involuntary care (or who could be reasonably foreseen to be at risk for receiving involuntary care) – where at the inpatient or outpatient level, must have:

A. 24 hour access to someone (whether staff or volunteer) who is:

• Trained in trauma informed care, Intentional Peer Support and communicating across alternate realities. 
• Trained in supporting and facilitating communication for both people in distress and for people who experience communication deficits. 
• Available within 15 minutes of a request to listen/ assist in person for at least 2 hours per day
• Available for the remaining 22 hours by phone, text, internet, or in person. 

Such services are deemed necessary upon request and are billable to insurance at reasonable healthcare rates.


B. Daily access to non-medication trauma-informed group learning experiences (whether offered by staff or volunteers), including a minimum of one of the following per day and four different modalities per week:

• Intentional Peer Support 
• Hearing Voices Network 
• Wellness Recovery Action Planning 
• Icarus Project Groups/ Activities 
• Harm Reduction for Coming off Psychiatric Mediations 
• NAMI Peer-to-Peer 
• Family Therapy 
• DBT 
• CBT 
• Art/ Creativity 
• Movement / Fitness 
• Stress-Reduction training (Yoga, Mindfulness, Meditation, etc) 

3. Mandatory review

Every instance of involuntary care or treatment will be considered as a system failure and a potential trauma risk for both staff and service recipients - whether involved as participants or vicariously affected as witnesses. In order to prevent further/ future personal distress or systemic re/traumatization, such persons must be offered access to:

• A safe, confidential, free avenue to process and make sense of their experience (within 1 hour). 
• Independent advocates (within 24 hours) to assist them to communicate their concerns and make recommendations for systemic changes, including the following: 

• coaching and in person communication assistance as requested to restore any relationships affected, whether in the healthcare setting or otherwise.
• an in-person incident debrief meeting with agency management within 1 week
• an in-person opportunity for facilitated resolution with others involved within 2 weeks

4. Penalties for non-compliance

Agencies are required to fully collaborate with these procedures and implement all reasonable remedial recommendations in good faith or face treble damages.