Podcast: Medical Model Errors and Omissions in Treating Mental Illness
From lobotomies to pharmaceutical advertising to forced treatment, let’s discuss some of the more taboo topics in the history of psychiatry. While some of these approaches are obviously terrible (especially in hindsight) others are in the gray area. Should pharmaceutical companies be able to advertise directly to the patient? Is it OK to force psychiatric treatment in certain cases?
What do you think? Tune in to today’s Not Crazy episode for a great discussion on the more controversial topics in the field of psychiatry.
About The Not Crazy podcast Hosts
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.
Lisa is the producer of the Psych Central podcast, Not Crazy. She is the recipient of The National Alliance on Mental Illness’s “Above and Beyond” award, has worked extensively with the Ohio Peer Supporter Certification program, and is a workplace suicide prevention trainer. Lisa has battled depression her entire life and has worked alongside Gabe in mental health advocacy for over a decade. She lives in Columbus, Ohio, with her husband; enjoys international travel; and orders 12 pairs of shoes online, picks the best one, and sends the other 11 back.
Computer Generated Transcript for “Mental Illness Medical Model” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Lisa: You’re listening to Not Crazy, a psych central podcast hosted by my ex-husband, who has bipolar disorder. Together, we created the mental health podcast for people who hate mental health podcasts.
Lisa: Hey, everyone. Today’s quote is, this is how betrayal starts, not with big lies, but with small secrets. And that’s by Shalini Joshi.
Gabe: Ok, so we got a lot
Lisa: A lot.
Gabe: A lot of e-mails about the anti-psychiatry episode that we did a few weeks back.
Lisa: I love the emails because most people agreed with me, so keep those emails coming, folks, and said that you, Gabe, were unnecessarily harsh.
Gabe: Who’s saw, who saw that coming?
Gabe: I mean, like you radiate negativity.
Lisa: Hostility and anger. I know. Yeah, who saw that I’d be the reasonable one? Yay me.
Gabe: I did not.
Lisa: Nobody saw that coming, yeah. One email even said they were afraid you might, quote, stroke out.
Gabe: That was my favorite one. That was my favorite. Yeah.
Lisa: So tell us, why were you so angry?
Gabe: Because having a point doesn’t give you the right to lie, and for me it makes it worse because this is so personal for me and some of the points of the psychiatric survivor and the anti-psychiatry movement are so valid and they deserve attention. But now the point is so much more easily ignored and it’s making life harder for people like me and other people with severe and persistent mental illness.
Lisa: Well, I feel like we said that in the episode, though.
Gabe: I feel like we did, too, I feel like we tried to discuss it and keep a middle ground, but clearly we did not.
Lisa: The email would, in fact, indicate that. Yes.
Gabe: So we decided that this episode, we’re going to dedicate the entire episode to some of the very real issues that the psychiatric survivor community is legitimately raising.
Lisa: Things like lobotomy, forced treatment, pharmaceutical advertising.
Gabe: They make a lot of very valid points,
Lisa: Yes, they do.
Gabe: And again, as I feel like we said in the original episode, they go so far to make it easy to ignore.
Lisa: That is a problem.
Gabe: Let’s talk about lobotomies.
Gabe: That . . . I . . . Lobotomies are bad. If lobotomies were still going on,
Gabe: We could all agree lobotomies are bad. Never, ever, ever, ever, ever, ever. I feel like we need some more evers, do lobotomies.
Lisa: Lobotomies actually are still going on, but in different ways and for different things.
Lisa: No, that’s actually true, yeah. It can be a treatment for epilepsy these days. For severe epilepsy, that doesn’t respond to other things.
Gabe: Really, but is it an actual lobotomy?
Lisa: Well, what do you define as lobotomy? The word just means removing part of the brain or severing connections between the brain.
Gabe: I think what we’re talking about, a psychiatric lobotomy, we.
Lisa: Well, yeah, we all know what we’re talking about, you’re right, that was off topic.
Gabe: I understand what you’re talking about, that things do evolve and potentially become beneficial, I guess, but when we talk about a psychiatric lobotomy, I mean, we’re literally talking about the ice pick through the eye.
Lisa: Yeah, yeah.
Gabe: We’re talking about removing the frontal lobe for no other reason than to control people’s or to make them more docile. I’m really not sure I.
Lisa: You know, Gabe, I don’t know if this matters to you, but they didn’t actually remove the lobe of the brain, they just damaged it or severed some of the connections.
Gabe: I, which?
Lisa: With an ice pick through the eye. Yeah.
Gabe: You are right.
Lisa: You are right. That does not make it better. That is not a meaningful distinction.
Gabe: I think that my way seemed more kind, your way is, like, we just poke at it until we get the desired behavior.
Lisa: Yes, and often done blind. Ugh, do not start reading about, well, one old timey surgical techniques or two, lobotomies. It’s just lots of bleah.
Gabe: I think we can all agree that lobotomies are bad, they’re not good, and they really served no purpose.
Lisa: And were quite damaging.
Gabe: We were surprised to find out where lobotomies came from. And we’re just going to give you a brief little history lesson just so that you can be as shocked as we were.
Lisa: Spoiler alert, it’s even worse than you think.
Gabe: Yeah, it is. I’m on the edge of my seat, Lisa.
Lisa: And to also just twist the knife on how incredibly horrifying it is, the guy who, he didn’t necessarily invent it, but he did popularize the lobotomy, won the Nobel Prize in medicine for this work. Yeah,
Gabe: Ok, but
Gabe: That. But wait, there’s more. And that’s not the worst part.
Lisa: As I was doing research for the show, I started to wonder, why was this a thing? Why were lobotomies used so much? Why were people doing this? And I found an interesting quote, and this is by Jason Brice, who is a famous neurosurgeon and worked back in the day in the 50s alongside one of the originators of the procedure. And he said, When I visited mental hospitals, you saw straightjackets, padded cells, and it was patently apparent that some of the patients were, I’m sorry to say, subjected to physical violence. And then why did you like lobotomies? We hoped it would offer a way out. We hoped it would help. So you specifically are saying that these people are being abused. So, hey, a lobotomy is a better option. You’re not evaluating it on its own merits. You’re just saying, you know, this would definitely be better than the abuse they’re currently receiving, the abuse that’s being done by your profession. That is so messed up.
Gabe: Yeah, it’s messed up and once again, notice it put the onus on the patient. It was the patient’s responsibility to fix what the staff was doing. So the group with no power.
Lisa: And his whole thing is and that’s why we promoted lobotomies. Why are you not saying and that’s why we really cleaned up asylums and made sure that the staff wasn’t abusing the patients? What is wrong with you?
Gabe: This gentleman and his little team came up with the idea to do lobotomies by walking through mental hospitals and seeing that the staff was abusing the patients and they thought to themselves, how do we stop patient abuse? I know. We’ll damage their frontal lobe so that they will be more docile and then the staff won’t want to abuse them.
Lisa: Well, it was more of, oh, the goal is to get these people out of the hospital and then they won’t be abused. Oh, perfect. The goal isn’t to make them better or to improve their functioning or to help them. No, the goal is just to take them out of the abusive situation, the abusive situation that you caused and are working for.
Gabe: And the way that we get them out of that is to just ultimately abuse them.
Lisa: In a different way.
Gabe: The reason that that I’m bringing all of this up is because I, as a 43 year old man, tend to think of this as it’s the past, right? This is something that happened in a world that has now gone. But I really didn’t consider the idea that people are alive.
Lisa: A surprising number.
Gabe: First off, people who received lobotomies in the 1950s are still alive.
Lisa: Well, lobotomies continued to be performed well into the 80s.
Gabe: Yeah, yeah, that was a, that was a.
Lisa: So lots of people are walking around who had this done to them, and of course, plenty of people are walking around with knowledge that this was done.
Gabe: Like their friends and relatives and, you know, we didn’t really consider the generational trauma of all of this. That this is, the best example that I have, Lisa, is, you know, when you took me to the emergency room and I was ultimately admitted to the psychiatric ward. We called my grandmother. My grandmother was born in 1936. And when I called her and I said, hey, I’m being admitted to the psychiatric ward, she said, I’m sending a lawyer. I’m sending a lawyer right now. We’re going to get you out of there.
Lisa: Don’t worry.
Gabe: Yeah. Yeah, don’t worry. I’m getting you a lawyer. What? I don’t, I don’t need a lawyer, Grandma. I need medical care. And for the longest time, I thought this was proof that she was a nutty old woman. Who sends a lawyer to a hospital, you crazy lady? Like, sincerely, right? But no, my grandmother remembers her neighbor who was committed against her will because her husband said that she wasn’t following the rules of the marriage. And boom, 12 weeks in a mental hospital. This is the trauma that my grandmother is, this is her experience.
Lisa: And what you’re referring to is that at one time, husbands, fathers, pretty much any man in control of a woman, could have her declared insane or crazy and forcibly admitted to an asylum.
Gabe: And you’re thinking, well, but they needed a reason, but that reason
Gabe: Could be refuses to have dinner on the table, back talks, wants to get a job, likes sex, doesn’t like sex. I mean, it’s just, you didn’t really need a quality reason. And most importantly, the woman had no say. She could be as calm, as rational and reasonable as the day is long. And that’s assuming that they even talked to her at all. They did all of their talking to, as Lisa pointed out, the nearest man. And I tend to think of that as something, well, that doesn’t exist anymore and that doesn’t happen anymore. But my grandma? She was alive when that was happening.
Lisa: And remembers some incidents of it quite vividly.
Gabe: Yeah, so.
Lisa: And this influences, so when you called her and said, hey, I’m going to go to a psychiatric hospital, this is her opinion of psychiatric hospitals and what happens there.
Gabe: Yeah, so when I say, why don’t you trust the medical establishment? Why do you have such a low opinion of them? My grandma’s natural response is, look, I couldn’t trust them in the 50s. I couldn’t trust them in the 60s. Why should I trust them now? And she’s passed that on to the people around her. She passed it on to me. Luckily I got better information, updated information, and I was able to get the help that I needed. And none of those things happened to me, not a single one. But that I should just tell my grandmother what? The medical establishment has moved on since that? They haven’t really done anything to make up for it. I mean, they’ve acknowledged that it was wrong and they shouldn’t do it, I think.
Lisa: Have they? Have they?
Gabe: We could not find a formal statement from any significant large medical organization, the American Medical Association, the American Psychiatric Association, the American Psychological Association, we could not find any documentation from a president, a board of directors that said we were unequivocally wrong and we were apologizing. We found a lot of information that said, well, those were the times. You know, what were we supposed to do? We were doing research. As soon as we realized it was wrong, we stopped. But they didn’t stop until they were defunded. So I’m. I’m not.
Lisa: It doesn’t seem like a sincere apology, is what you’re saying,
Gabe: It doesn’t.
Lisa: And again, I couldn’t trust you back then, you were doing all this bad stuff at the time. You’re apparently not that sorry for it. You haven’t really apologized, but. Oh, no, you’ve changed. You’re different now. The bad days are behind us.
Gabe: And this is what’s a little bit rough, right? I personally do believe that the bad days are behind us.
Lisa: You are wrong.
Gabe: Well, they’re no longer forcibly doing lobotomies and they’re no longer admitting wives based on their husbands’ say so. A lot of these things can’t be done any more. No matter how hard I try, I cannot have Kendall committed because she won’t make dinner. My wife, I can’t just have her committed because I want to, but I might be able to get her committed if I say the right words. So it’s no longer the slam dunk that it was. I need you to commit my wife because she won’t obey my commands. That won’t work anymore. But maybe you could say, look, she’s crazy. Here’s what I have observed as her caregiver or patient advocate. I mean, we’re doing a lot to remove HIPPA laws, for example, and people think that’s reasonable. To take the medical privacy rights away from people with mental illness for their own good. This is a big advocacy point and one that we well should fight back against because all kinds of negatives can come out of that.
Lisa: There’s a lot of for your own good type things when it comes to modern psychiatry. Medication, hospitalization, all sorts of things. Paternalism is still very much there and it’s very much about infantilizing the patient.
Gabe: As your quote said, Lisa, there’s just like death by a thousand paper cuts.
Lisa: Well, some would argue these aren’t papercuts, these are stab wounds.
Gabe: But let’s go with that they’re paper cuts. They’re little, right? See when I think of medical malpractice, I’m thinking of the forced lobotomy, the your husband can have you committed, the people who spent literally years in an institution, despite, frankly, being smarter than both of us combined. They just were poor or impoverished or a minority or a woman, which is just rooted in racism and misogyny. But all of the things that I’m talking about now, they seem small in comparison. Now that that could be a false equivalency. I completely understand that, but I do feel like we’ve improved because these are smaller, but I do feel that they erode trust and faith in the system, which erodes faith in the outcome. Is that how you see it, Lisa?
Lisa: Yes, 100%. When you say they’ve improved. Well, so what? Oh, it’s better now. Well, it still ain’t good is it? And if you’re the person suffering right now, the fact that, oh, hey, your suffering could have been way worse 30 years ago. That is not comforting. You don’t want it to be way better, you want it to be gone.
Gabe: You’re not wrong. You know, I’m struggling to find words here because.
Lisa: When you say it could be worse, you’re saying that this person, the hypothetical psychiatric patient we’re talking about, should just shut up and be grateful. How condescending and dehumanizing is that?
Gabe: We see a lot on social media where people watched a YouTube video and declare themselves experts and start demanding things from their doctor. And to a lesser extent, I think the pharmaceutical companies are playing on this. Because replace YouTube video with recent commercial.
Gabe: So now we’ve got a doctor, went to medical school, researched this, studied this, passed the boards, seen hundreds, thousands of patients and one of their patients comes in and says, I want Xikal. Well, why do you want Xikal? Because last night, when I was depressed, I saw an ad that had cute little bubbles or a lady jogging in the, it’s always power walking now, I don’t know why, in the mountains who made up with her mother, sister, boyfriend, whatever. You know, she’s now connected with her children and she took Ziklakal, or whatever fake name I made up earlier. And based on the strength of that commercial, they now know more than the doctor. And the pharmaceutical company argues, no, no, no, no, no. We’re just making them aware.
Lisa: And they even say things like talk to your doctor. Uh huh.
Gabe: And they hide.
Gabe: They hide behind the idea that, no, no, no, this is between you and your doctor, but your doctor doesn’t have a multimillion dollar advertising budget to prove that they’re the expert and the pharmaceutical company is not. And the pharmaceutical companies know this.
Lisa: America is the only place that has direct to consumer pharmaceutical advertising, and it’s also the place where drugs are the most expensive. Almost like that’s not a coincidence.
Gabe: Lisa, in the interest of full disclosure, it’s important to mention that PsychCentral.com does take pharmaceutical advertising. I have contracted with many pharmaceutical companies and hopefully will continue to contract with pharmaceutical companies. So I just wanted to give a quick conflict of interest statement that both PsychCentral.com, Gabe Howard, Lisa Kiner, the entire enterprise, if you will, has absolutely taken money from pharmaceutical companies, hospitals, medical companies, conferences, etc.
Lisa: Yes, transparency matters, and we just wanted you to know.
Gabe: Yup. I feel like pharmaceutical companies know what they’re doing. I don’t think that they’re completely misleading the public. I think it’s more sinister than that. Right?
Lisa: I think this is a for profit company and their goal is to sell product and if their product happens to be medication, well, their goal is to sell it. It’s just capitalism. There’s not ethics or morality involved, it’s just economic. And not for nothing, if my goal is to sell my product, then I have a vested interest in as many people as possible needing my product. So saying that, oh, hey, this drug used to be for this, oh, it turns out you can use it for that too. Or, oh, well, you know, we didn’t used to medicate people that were at this level. Well, but wouldn’t they be better off if they were? The goal of a pharmaceutical company is to have everybody in America have mental illness and therefore need said medication.
Gabe: And see, I don’t like that. I don’t think that’s true. I think you’ve gone too far the other way
Lisa: How is that not true?
Gabe: To say that the pharmaceutical company is all sitting in a meeting saying, how can we trick everybody who doesn’t need this medication to take a medication they don’t need? I think that sounds very, what’s the word? Conspiracy theory.
Lisa: Well, it does sound that way, and that’s not what I’m saying. You don’t have pharmaceutical employees and executives sitting around diving into a pile of gold like Scrooge McDuck. No, that’s not what’s happening here. The point is that money changes things. And whenever you put money into any given situation, people start to have bias. And maybe it’s just a tiny little bit, but it’s still there.
Gabe: That’s what I mean by little things that start eroding. I personally don’t like the idea of direct to consumer advertising because I think that you should tell your doctor your symptoms, have a partnership with your doctor, explain what’s happening, and your doctor should decide the best medicine for you.
Lisa: Well, but not your doctor should decide, you and your doctor should decide together.
Gabe: Yes, yes, completely agree, but this gets problematic as well, because I know many patient advocates, hundreds at this point over a 10 year career, that tell me that the way that they found the treatment that worked for them was it was recommended by another patient.
Lisa: Oh, OK.
Gabe: Well, now this gets tough, right? Because when another patient is like, hey, look, I took Xeniklein, I keep changing the name, but at least it always starts with Xen. And then they talk to their doctor about it and they get it. Like, I feel that there’s like a personal empowerment there, right?
Gabe: When somebody says I have the same illness as you and this is a treatment that worked for me, why don’t you go talk to your doctor? I think that it’s pure, but for some reason, when the pharmaceutical company advertises, hey, use this medicine and you’ll be able to make up with your mother, who you’ve been fighting with for 15 years, and go for power walks through the mountains or connect with your children and do water colors. That’s another like common theme, water color, I don’t understand this at all,
Lisa: It’s always raining at the beginning and then it’s not necessarily super bright and sunny, but it’s definitely not overcast by the end.
Gabe: And the people they get to play depression on these things, they’re so depressed, they’ve made their pets depressed.
Lisa: I love that.
Gabe: Yeah, the dog is miserable.
Gabe: This is where it’s very, very difficult. On one hand, I think that patients having information is a good thing. And you can argue that all the pharmaceutical companies are doing is giving the patient information. But I don’t think they’re sticking to facts. I really don’t.
Lisa: But where’s the line? It’s not necessarily straight up lying, but it’s advertising.
Gabe: It’s puffery.
Lisa: There’s an element of puffery, right. You know, world’s best coffee. Is your coffee really? Really? How did you determine that? But no one has a problem with that statement in an ad.
Gabe: It’s not a small house, it’s a cozy house.
Lisa: Well, just we all understand that’s what advertising is. So that’s true with drugs as well.
Gabe: I want to challenge that exact statement right there. You said that people understand advertising, that they understand that it’s puffery and they understand. Like that’s the base premise, of Americans understand advertising. But
Lisa: No, they don’t.
Gabe: You literally just said Americans understand it’s puffery.
Lisa: Well, I should have phrased that differently because obviously, if everybody understood that advertising was bullshit, then we wouldn’t have advertising. The point is that we all understand there’s some element of that, but we don’t think it all the way through to its natural conclusion.
Gabe: That’s the specific part that I want to sort of address here. When you are sick and desperate, are you less likely to acknowledge that the advertisement is puffery? Or are you more likely? For me, when I watch the sports car commercial, the guy in the suit with no tie next to the beautiful woman and the top is down. Vroom, vroom. Yeah, look, I know that if I buy that car. Yeah, yeah. I’m still going to be this. I get it. But let’s say that I was really desperate. I’m sick. I’m not thinking right. I have mental illness and I see an ad that promises me that if I buy that car, it will cure my depression, bipolar, psychosis, schizophrenia. Does that mean I’m more likely to buy the car just because at this point I’ll just do anything?
Lisa: Yes, yes, it does. That’s what advertising is.
Gabe: Is that wrong? Is it wrong to manipulate sick people in this way?
Lisa: Well, but nobody works for free, you know?
Gabe: You keep talking about capitalism, advertising, nobody works for free, but listen to my exact words. This particular advertising is essentially misleading desperate and sick people. It’s a subtle mislead. Because, you know, it’s got the thing at the end. Talk to your doctor. Your results may
Lisa: It’s preying on your insecurity.
Gabe: It’s praying hard on your insecurities and your desperation, and in the case of mental illness, it’s praying desperately on the part of your brain that’s not working.
Lisa: Yeah, that’s fair.
Gabe: Let’s pick apart the ad where it shows you depressed. It doesn’t, I’m not picking on any pharmaceutical company, they’re all the same.
Lisa: They’re all the same.
Gabe: It starts off, you’re depressed, your dog is sad. It’s raining. It’s not so bright.
Lisa: The dog is laying on the couch looking sad, he puts his little nose down.
Gabe: It’s a mess, and the specific point I want everybody to zero in on is by the end, you have connected with your significant other, your family, your friend, your children. And the reason that I want to specifically address that is because, one, it makes it sound like the medication did that all by itself. It also takes everything away from the other people. How are they coming to terms with your change? It makes it sound like as soon as you take this medication. Let’s say that it works like gangbusters, your depression lifts immediately. You are perfect. Like. Like what? You don’t have to do anything else? No therapy. You don’t have to make amends. You don’t have to apologize. It’s just like that. Just perfect. You take the pill and you’re back in everybody’s lives. What about those people? Your illness impacted them in some way. They just immediately forgive you because of magic pill? That part, in my opinion, is frankly just a lie.
Lisa: Well, it also biases the public against a non pharmaceutical treatment, right? It says things like only your doctor can diagnose depression, talk to your doctor, the underlying medical cause of depression. All of these things imply that I should go to a medical doctor for treatment of this problem. It never says things like, hey, have you considered therapy?
Gabe: Oh, I see what you’re saying.
Lisa: Maybe some CBT would help you out? Maybe there are some other interventions that are not drugs that might be useful to you.
Gabe: It paints depression in this very narrow and again, we’re sort of talking about antidepressants at this point,
Lisa: Well, they’re the ones with the best ads.
Gabe: But it sort of paints depression in this very narrow way. So you could be suffering from grief.
Gabe: And it looks a lot like the way that they describe depression. And I know they have all these, it may be depression. Only you and your doctor, like you said, they don’t recommend therapy first. They don’t say two or more weeks. They just, you’re right. It really, and it’s pummeled, pummeled by money. I can’t watch anything on TV without seeing these ads and this very narrow view of something that is significantly more complicated.
Lisa: Well, speaking of more complicated, they always say things, like it’s a chemical imbalance, or they have little diagrams that is supposed to be like the serotonin in your brain and here comes the drug and it knocks it aside. And that’s not real. None of that is real. That is not an accurate representation of how these drugs work. And doctors and scientists know this, but this is the popular perception and that perception comes through advertising. These ads all heavily promote the whole chemical imbalance theory of mental illness. When we know that in real life, it’s way more complicated than that. There are lots of other factors.
Gabe: Actually, what we know in real life is that we don’t know
Lisa: Well, that’s fair.
Gabe: That’s the reality. Any pharmaceutical company, any psychiatrist, any doctor will say we don’t know how they work. We just know through studies that they do.
Lisa: We think this might be how.
Gabe: I want to be very, very clear, I don’t want everybody listening this to stop taking their antidepressants. They know that they work through rigorous testing and through rigorous studies. And of course, if you are taking them and they are working for you, then that’s enough. If your life is improved because of it, then you have done their part. I don’t want anybody listening to this to think, aha, it’s all bullshit, I’m done. That is not the message. Just because you don’t understand how something works, doesn’t mean it doesn’t work. Remember in the Middle Ages we didn’t know how gravity worked, but gravity still worked. Not understanding something is not the same as it’s bullshit.
Lisa: We’ll be right back after these messages.
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Lisa: And we’re back with more of Gabe and me being Not Crazy.
Gabe: I want to pivot just ever so slightly, Lisa, and talk about the fact that hundreds of millions of dollars in advertising has also created this false narrative in the public’s mind. If you have a mental illness, take a pill and you’ll be fine.
Gabe: So whenever anybody like me with serious and persistent mental illness has a problem, the knee jerk reaction, because of all this advertising, is take your meds.
Gabe: Why don’t you take your meds? Why isn’t he just med compliant? There is literally a multibillion dollar advertising campaign that’s gone on for, what, a dozen years?
Lisa: That’s an interesting point.
Gabe: That has promoted the idea that medication is all that people with mental illness need and they’ll be fine.
Lisa: And that it works 100% of the time, always.
Gabe: And it reinforces this if things go well, you have a great doctor. If things go poorly, you have failed as a patient. Isn’t that awesome?
Gabe: Every bad thing is your fault. And every good thing we owe to the medical establishment. We never get credit for our hard work and they’re never held accountable for failure.
Lisa: That is an excellent point that I hadn’t considered, because obviously the point of an ad is to convince you that the product works, and it must work extremely well, and it must work extremely perfectly, and it must work extremely easily because otherwise, why would I want it? In real life, psychiatric medication doesn’t work like that. You’re right. That is putting in people’s minds this idea that, hey, this stuff works. Swallow your pill, you’ll be good.
Gabe: And in some ways, it’s even worse than that, I hate throwing pharmaceutical companies under the bus because, listen, without my medication, without them, I would be dead, and, Lisa, without them, you would be dead.
Lisa: We both do take psychiatric medication and we both believe that it works very strongly.
Gabe: Forget about psychiatric medication, look at all the advances in all the other illnesses. We’re sitting there, you know, trashing them, but I guarantee if you need surgery tomorrow, you’re going to want anesthesia. Who developed that?
Gabe: Are you going to be OK dying of? I mean, what about antibiotics?
Gabe: Just stupid pharmaceutical companies and their stupid antibiotics. I want to get scratched on a fence post and die like 100 years ago.
Lisa: Right, that’s fair.
Gabe: Come on. They’re funding research that that is allowing us to live for, you know, my grandfather’s 90 years old. That’s because of medical science and the hard work of the pharmaceutical industry. So they’re not all bad. And to pretend that they are is disingenuous at best. But again, it doesn’t mean they don’t have problems.
Gabe: And one of the problems is they need a certain narrative, and we’ve already discussed how that narrative is pushed in their advertising, prime time advertising, multimillion dollar advertising. But that narrative is also pushed in the organizations that they support. Pharmaceutical companies support by far more family member organizations and caregiver organizations. And their top spokespeople are not people living with mental illness. Their top spokespeople are family members of people living with mental illness. There’s a stigma and discrimination in their funding. They want to make sure that they’re funding their narrative, and accuracy kind of takes a back seat. Their narrative is true, it’s just, it’s not 100%. Family members, they have a vital, vital message to deliver. The problem is, is that their message is so well-funded, the patient message is drowned out simply because of financing.
Lisa: Ok, Gabe, well, what would you like to see them do instead?
Gabe: The easy answer is I’d like to see them not be allowed to advertise on television. I’d like to see them engage the patient voice more. I’d like to see them give equal funding to patient advocacy groups, as they do to other advocacy groups that have like peer council seats or consumer council seats. Because the entire board is made up of people without the illness, and then they have to have a token non-voting chair for people with mental illness as an advisory role, because after all, one person with mental illness in a group of 20 that’s not allowed to vote, that’s going to affect real change. And for the record, ladies and gentlemen, I’m not just pulling that out of my ass. That happened to me at a national mental health charity.
Lisa: That’s happened to you several times, you’ve been asked to be the token.
Gabe: That, they can do that. They can start putting their resources behind that. If their goal is just to sell more drugs, than business as usual.
Lisa: Well, of course, their goal is to sell more drugs. That’s what companies’ goals are.
Gabe: Yeah, and that’s why they need to be held accountable. The pharmaceutical companies, the medical establishment should, in fact, be held accountable for the fact that their decisions, their resources, their money and their time is making life harder on the people whose backs they’re making money on. That’s not OK. They are looked upon by society as heroes who are saving people with mental illness. And that’s where we get phrases like just take your meds, be med compliant. Well, if they’d only take their meds. Oh, my God, why are we seeing this person again? Just drug him. The drugs are looked at as magic cures created by a benevolent company that only hugs and loves and cares.
Lisa: It’s also telling you again that there is an underlying biological cause that is the main reason. It’s not about trauma or environment or anything else. The main reason you’re having this problem is because there’s something underlying wrong with your body. And therefore, why wouldn’t you take the drugs? If you just do things like therapy or DBT or those types of things, you’re not addressing that root cause that they have convinced you exists.
Gabe: Yes, it would be nice if they would also fund wraparound services, because I got to tell you, if you’re committed to a psychiatric ward, if you live in a group home, if you are homeless, if you don’t know where your next meal is coming from, the very fact that people are pushing medication on you? It . . . that’s just not, that’s not what the person is. The person is cold and hungry and, and just.
Lisa: Well, but if it makes you feel better, they’re not pushing medication on that person because that person is not that profitable. These advertisements are not geared toward people who are poor, they are geared to the middle class.
Gabe: The medical establishment is looked at as the savior of all the people with mental illness. And as you just pointed out, they ain’t focusing in on the sickest of the sick, are they?
Lisa: No, because those people don’t pay well.
Gabe: And that alone goes back to our theme of it erodes trust and faith in the system, which erodes faith in the outcome. It also goes back to the look, we couldn’t trust you to look out for our best interests then. Why should we trust you to look out for our best interests now? Maybe my grandma is right.
Lisa: Ok, your grandmother was not right about let’s get you out of the psychiatric hospital on the day where you desperately needed hospitalization. She was not right about that. And we both agree on that, we both agree that you needed to be there.
Gabe: She was wrong, completely wrong. She just wasn’t crazy.
Lisa: Yeah, she wasn’t unreasonable, she was just wrong. And when you say maybe she’s right, you mean right about the fact where you can’t blindly trust doctors or other institutions? Yes, she’s right about that. Is that a debate? Are we debating that?
Gabe: I used to debate that.
Lisa: Oh, that’s so sad.
Gabe: Lisa, I think we’ve picked on pharmaceutical companies enough, so let’s go ahead and piss off doctors and hospitals and let’s just throw in politicians while we’re at it. And I’m thinking specifically of forced treatment, and forced treatment looks a lot of different ways in different states. And you may be familiar with like AOT, which is Assisted Outpatient Treatment. There’s Laura’s Law, there’s court ordered treatment, there’s community treatment, there’s forced medication, there’s pink slipping, there’s being committed. There’s involuntary compulsory treatment. Some of these involve community based, meaning you’re required to take medication and show up for therapy, but you’re allowed to move about your home and community. And then others are the traditional commitment method that we all think of, which you’re in a hospital and you’re locked behind closed doors. The bottom line is, it’s against your will. You have not agreed to this. And you are being ordered by the justice system, by the courts, by the government to do something about your health.
Lisa: Under penalty of arrest or jail. When you say that it’s required, it’s required literally by law. With punishment, if not done.
Gabe: There’s a bit of a nuance here, and I want to break it down a little bit. One, if you are a danger to yourself or others, if you’re going to hurt yourself or hurt somebody else, Gabe and Lisa are 100% in favor of forced treatment, commitment, et cetera.
Gabe: If you have committed a crime, diversion programs, mental health courts, all of these things. I understand that if you cannot follow the rules of society that something has to happen. We can’t just let people commit crimes and say, oh, mental illness and walk on. So all of that makes sense. The specific forced treatment that I am speaking of is you have broken no laws, you have done nothing wrong. But somebody has decided that for your own good, the following things need to happen because you will be better off for it. And then you are adjudicated. Literally, you go before a judge and the government orders you, against your will without your feedback, to do something under penalty of law.
Lisa: Yeah, and often without a lawyer.
Gabe: And in some states or cities, often without them.
Lisa: Without the judge part, yeah.
Gabe: Well, I was going to say paying for it, but you’re right, sometimes there’s not even a judge and now you are in this bureaucratic nightmare. It’s very clear in a lot of these laws how to become enmeshed in this system. They know how to force you into treatment, but it becomes extraordinarily murky on how to get out.
Lisa: Well, don’t you think that’s going to be today’s lobotomy? We look back and say, oh my God, look at all these things they did to psychiatric patients in the 50s. Look at all the damage. Look at all the generational trauma. Don’t you think in another 50 years we’re going to be going back on this?
Gabe: I personally do. I get a lot of pushback on this. What? It’s OK to leave people who are sick just wandering around? No, that’s not OK, but picking them up and having a judge order them to get better. Listen, doesn’t that sound like nonsense? I mean, seriously.
Lisa: Also, really? You don’t think that’s going to turn out badly? Really? You found a way that someone can be compelled to do something because other people think it’s a good idea. Again, they haven’t committed a crime. They’re not dangerous. And you don’t think that’s going to be used on the most vulnerable people in society? That’s not going to turn out well. How could you possibly ever think that’s not going to be a mess?
Gabe: I agree with everything you said, but I’m going to go a completely different way. Lisa, I hate the length of your hair. How many times have I said you are a, I’m pretty sure you’re going to beep out whatever age I say. So you are a woman of a certain age and you have long ass hair down to your butt.
Lisa: It looks fantastic,
Gabe: And I hate it.
Lisa: It’s golden and beautiful.
Gabe: So let’s say that we live in some, I don’t know, world where I want you to cut your hair. You don’t want to cut your hair. And for reasons unknown, I can take you to court. All right, fine. So we go to court. We’re going to say that you have all the money that you have now. So you actually have a real lawyer, which most of the time, if you get a lawyer at all, it’s a public defender who’s overwhelmed with other things. But just forget all of that. We go in front of a judge and the judge agrees with me. The judge actually says to you, hey, Lisa, you are required by law to cut your hair. Now, you are a law abiding citizen. You think, well, maybe Gabe has my best interests in mind. And you cut your hair. Now you comply. The judge says you’ve complied. You keep that haircut for as long as you’re in the system, we’ll say that’s two years. Then you get out of the system. Now you are completely out of the system. It is over. What is the first thing that you do?
Lisa: Grow it out.
Gabe: Right, and what’s the second thing that you do?
Lisa: Make sure that I never, ever come near you again.
Gabe: Yeah, so maybe for two years I got my way. For two years, Lisa’s hair was exactly how Gabe Howard likes it. But after that, it’s over, and you’re probably going to get worse. Before you only grew it down to your butt. Yeah, now you’re stepping on it. You’re getting bangs. Yeah. You don’t care. You’re going nuts.
Lisa: Yeah, absolutely, there are plenty of harmful behaviors or things that I don’t like or that we think other people shouldn’t be doing for their own good that you don’t get to court order them not to do. Smoking, ridiculously dangerous. I can’t take my grandfather to court and demand that he quit, that a judge enforce what is best for him. And quitting smoking is, in fact, best for him.
Gabe: We can’t line up all our overweight relatives and drag them in.
Lisa: Yeah, we cannot enforce these rules on other people for behaviors we don’t like or that are, in fact, bad for you. Where’s that going to end? Once again, why does no one see the potential for abuse in this system? Who thought this was a good idea?
Gabe: I’m fascinated by mental health charities that loathe bureaucracy in the mental health system.
Lisa: Good point.
Gabe: The mental health safety net is filled with holes and the bureaucracy is stopping people. And we pay more people to watch it than we do to help people. And then they advocate for more bureaucracy. They advocate for the government to get involved in our health care. We can’t even get the government to give us health care, but they’re going to spend money to order us to get health care.
Lisa: That’s actually become a debate in many states. That if you are ordered into treatment, does the state have to pay for it?
Gabe: That is probably one of the final points that I want to make on this topic, just because you are ordered into treatment doesn’t mean that they’ll pay for it, and it doesn’t mean that you will get good treatment. You very well could be ordered into substandard treatment, literal garbage.
Lisa: Or not be able to find a place at all. And then the question becomes, what happens now? If there isn’t a place available in the program, is that person still court ordered to get in there somehow? That has also happened.
Gabe: There’s also studies that point out, of course, that while we’re forcing people into treatment, people who are ready, willing, and able, people who want treatment, are being bumped off the list because after all, the court ordered, people by law have to go first. So Gabe is court ordered and he doesn’t want it. Lisa wants it. Gabe gets in. My odds of being successful are relatively low because I am not participating in my own care. Your odds of being successful are higher because you are willing to participate in your own care. You’re bumped, I’m in.
Gabe: What kind of a garbage system is this?
Lisa: Yes, and as you pointed out, it makes you distrust the system. People who are forced into treatment are not feeling positively about doctors and medication and therapy and things that could potentially be extremely helpful to them, and are probably not going to continue it and are not going to be interested in trying in the future.
Gabe: In my opinion, that’s the real loss. When they are ready, when you now try to pivot and partner with your loved one or your patient or whomever it is, when you want to try a different route, they’re so traumatized from, frankly, the nuclear option, that they don’t trust you anymore. You have now lost that rapport. I think that there are better ways to work with the seriously mentally ill. I am not advocating doing nothing. But, my God, wouldn’t it be great if we could just go pick up mentally ill people, have a judge, order them to get better and poof, they were better? That sounds like nonsense, but these are the advocacy points that we’re dealing with. And people get caught up in this system forever and adjacent to all that, they have the same problem that we have with the pharmaceutical advertising. The pharmaceutical advertising creates this idea that medication is magical and that all people with mental illness will be better if they only just take their meds. And that’s problematic for the way that society treats and responds to us. And it creates, in my mind, just tons of discrimination and stigma opportunities. Move that aside. Now we have to have special laws for people with mental illness. So when Gabe Howard goes to get a job, they’re thinking, wow, this guy has to have a special set of laws because he has bipolar disorder. I’ve seen it on the news. I’ve read it in the paper. So now there is this massive, I don’t want to call it an advertising campaign because nobody’s actually advertising it. But there’s a massive conversation going on about what to do about the mental illness problem. And one of the ways that we need to do it is to what? Make it illegal? We need to involve the government and the court system. And now just regular people are reading in the paper, oh, hey, people like Gabe, people with bipolar, are so dangerous, we need a special set of laws for them. I’m starting to think that I wouldn’t hire me.
Lisa: That’s a good point. It defines this group as problematic.
Gabe: It does. It creates this idea that we suck and that gets airtime, so much airtime.
Lisa: It reinforces the idea that everyone with mental illness is dangerous and needs to be handled specially.
Gabe: Study after study after study shows that this does little good. It costs money, it takes resources away from people who need it
Lisa: And want it.
Gabe: And want it. And frankly, it just hasn’t shown to do any good. But, people cling to this as if it will save lives. I want to be clear, it doesn’t work. And it’s certainly not the best that we can do. Not by a long shot.
Lisa: And don’t forget that even when forced treatment is necessary, and we both agree that sometimes it is, there is an extreme amount of trauma involved in this. Being forcibly committed is traumatic.
Gabe: It’s very fascinating to me because this is how we treat people with mental illness. It’s for your own good. This is what you need to do. And we don’t have this in physical health. Lisa, when n you were a kid, you had a lot of surgery. Could you imagine if when you were 16 years old, and you were in the hospital waiting on your surgery and you would have been scared. Mom, I’m scared. I’m scared. And your mother would have looked you in the eyes and said, this is for your own good. You shut up.
Gabe: Like, people would have thought that she was the worst mother on the planet.
Lisa: And of course, that’s not what she did. She reassured me, she told me it would be OK. She bought me a special teddy bear, on and on and on. So this is not how we treat other medical problems.
Gabe: You guys had rituals even around the recovery.
Lisa: We did.
Gabe: That’s an awful lot of kindness, love and support that they gave you over something that was for your own good.
Lisa: Well, it wasn’t just my parents, everybody did. Our extended family, friends and family, doctors and nurses give you a lot of support and love and positivity that this is all going to be OK.
Gabe: And we don’t have this often.
Lisa: No, we really don’t.
Gabe: I have read so many articles called Mental Illness is Not a Casserole Illness. Nobody sends you cards, nobody bakes you food, nobody offers to clean your house. People constantly tell you, well, this is where you need to be. This is for your own good. You better do it. You need to get your shit together.
Lisa: There’s an element of shame.
Gabe: There’s no support whatsoever. I want to be clear, in this scenario, Gabe and Lisa 100% agree that this person needs to be committed against their will. We are positive. They are a danger to themselves or others. They need it. It is important that laws like this exist, but the laws are mostly already on the books. We’re just not using them.
Lisa: But the whole process is still very punitive. It’s always seen as you’re bad and we need to do this. You’re bad, you’re bad, you’re bad. That is just completely reinforced over and over and over again. It’s never meant to be a supportive, loving thing.
Gabe: The best that we can do is get our shit together. We’re either actively sick, and therefore a problem, or we got our shit together, we got cleaned up, we got it together. There’s no positive on the other side. I would love it if we talked about mental illness using the same language that we talk about fighting other illnesses. I really wish that people would see that people are sick and that we’re doing the best I can and that address some of this stuff. It is traumatizing. It is traumatizing to be put somewhere against your will when you are sick and have doors locked behind you and told what to do. And the fact that that is very seldom addressed, I don’t even have words. And we have just scratched the surface of what society could do better, of what hospitals could do better, of what the medical community could do better.
Lisa: So the bad old days are certainly still here. They did not go away.
Gabe: They’re just different.
Lisa: Yeah, it’s different, but it’s not gone.
Gabe: Lisa, it’s fascinating. Now that we’re at the end of this show, people are thinking, oh, my God, we can’t trust the medical community, we can’t trust doctors. I mean, even politicians are out to get us. People with mental illness that have nowhere to go. And if you go over and listen to the anti psychiatry side, you’re like, oh, they’re using false data. They’re twisting their numbers. They think that people will magically get better through, will, light and hope. That’s not a good message either. And that’s why I believe, I believe so strongly, that the truth lies in the middle. We need to be aiming for that middle road and fight for that middle ground. It’s difficult to be in the middle. You know, when I got started, I thought all the people in the middle, they got loved by both sides. It turns out that all the people in the middle, they just get hated on by both sides. I can only imagine the emails that we’re going to get about this episode saying, oh, my God, how can you attack doctors? How can you blame doctors for stuff that happened in 1935?
Lisa: Because they’re still doing the same stuff, whatever mechanism it is they use to decide that was a good idea back then, they’re still using to decide.
Gabe: Lisa, I can’t wait to see the emails about this episode just barreling down on us, but listen, we want the emails and we do, in fact, read them all and we reply to as many as we can. Our email address is [email protected] Listen, the majority of the emails that we got, they were very kind. People wrote to us and said, you know, Gabe and Lisa, we respect you very much, but you got this so wrong. People told us of trauma that they experienced. People told us of situations that happened to them. And they asked very kindly why they should support a system that allows this to happen, that continues to do this. We answered as many as we could. We apologize if we didn’t get to yours. Thank you. Thank you for being open and honest and honestly respectful, because we did get some emails that said you guys are dipshit morons. We like those less.
Lisa: Most of them were good, though.
Gabe: Most of most of them were very kind.
Lisa: And again, most of them did agree with me, so I also enjoyed that aspect of it. But even if you did not agree with me this time, although I don’t see why you wouldn’t, you definitely want to email us and tell us what you think at [email protected]
Gabe: When did you become the rational one?
Lisa: I know it’s so exciting, so many interesting changes happening here.
Gabe: And one of the changes that’s happening is that Not Crazy is growing exponentially, and that’s all because of your hard work. Thank you so much for rating us, ranking us, sharing us, emailing about us. Just leave us a review. Use your words and as many stars as you feel appropriate. And remember, if you stay tuned after the credits, there is a really cool outtake that’s been curated by the great Lisa Kiner.
Lisa: And we’ll see you next Tuesday.
Announcer: You’ve been listening to the Not Crazy Podcast from Psych Central. For free mental health resources and online support groups, visit PsychCentral.com. Not Crazy’s official website is PsychCentral.com/NotCrazy. To work with Gabe, go to gabehoward.com. Want to see Gabe and me in person? Not Crazy travels well. Have us record an episode live at your next event. E-mail [email protected] for details.
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Podcast, N. (2020). Podcast: Medical Model Errors and Omissions in Treating Mental Illness. Psych Central. Retrieved on September 23, 2020, from https://psychcentral.com/blog/podcast-medical-model-errors-and-omissions-in-treating-mental-illness/