Broken Systems Impact lives
I have been on both sides of the fence of mental health services. I have been a ‘patient’ and I have worked as an Integrative therapist for the NHS and non-profit organisations. When emotional distress, trauma and pain are understood through the lens of pathology, I feel saddened and fearful. I have experienced first and second hand, the ways in which power, systemic oppression and pathologically broken systems impact the lives of divergent minds.
I often find myself reflecting on questions such as:
- Who decides what are ‘typical’, ‘natural’ or ‘normal’ responses to painful experiences? And:
- Who has the right to decide which natural, individual variations constitute a disorder?
So, when I saw that a Drop The Disorder, AD4E event was being held online this year, I was so excited to be able to attend. This extraordinary 14-hour global festival was packed with incredible speakers and truth-tellers; a powerhouse of change-makers who together, provided lens shifting insights into the culture of psychiatric diagnosis.
There is no going back from hearing the content shared in an event like this. No way of un-knowing the potent and profound evidence presented. I experienced a surge of energy as I listened, and a need to share the content with others. When the curator, Jo Watson, asked if I would write a short reflection about my experience of the event, I was delighted to be able to try to put into words what I had heard.
I wasn’t sure at first what an online festival would be like, or how the emotive content would translate through this medium. I can safely say that the experience was like no other. To have the opportunity to witness the stories and the poetry shared, was such a privilege and I found myself becoming increasingly impassioned as the event went on.
Limitations of Psychiatry
Dr Lucy Johnstone’s first presentation spoke to the limitations of Psychiatric practice. We heard about the absence of biological markers in psychiatric disorders and how the process by which people gain a diagnosis, is both highly subjective and scientifically flawed.
For anyone listening who may have started out feeling sceptical, or concerned that the event was part of a war on Psychiatry, it was important and powerful to hear the concerns echoed by Psychiatrists too, including authors of the diagnostic manuals themselves:
“We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting” (Dr David Kupfer, chair of the DSM-5 committee).
“There is no reason to believe that DSM 5 is safe or scientifically sound …There is no definition of a mental disorder. It’s bullshit” (Dr Allen Frances, Chair of the DSM IV committee).
“Patients … deserve better…The weakness is its lack of validity” (Dr Thomas Insel, former NIMH director).
During Jo Watson’s interview with Dr Paula Caplan, we heard more about the implications of the deleterious foundation, upon which the diagnostic manuals are built. She covered so much in her presentation, including a call for a safer system. Dr Caplan, along with many of the speakers in the event, have been raising their concerns for some time.
“The marketing of the DSM has been so effective that few people — even therapists — realize that psychiatrists rarely agree about how to label the same patient. As a clinical and research psychologist who served on (and resigned from) two committees that wrote the current edition of the DSM, I used to believe that the manual was scientific and that it helped patients and therapists. But after seeing its editors using poor-quality studies to support categories they wanted to include and ignoring or distorting high-quality research, I now believe that the DSM should be thrown out” (Caplan, 2012).
The medicalisation of human suffering
Dr James Davies expanded on these themes in a compelling 30-minute presentation: ‘The making of mental disorder’. In it he explored:
- The medicalisation of human suffering and the pathologization of people’s natural responses to the painful experiences of living.
- How Psychiatric drugs are more ineffectual and unsafe than many of us have been led to suppose.
- How enmeshed Psychiatry and Pharmaceutical companies have become.
- How there has been an astounding increase in the number of diagnoses added into the ‘psychiatrist’s bible’.
- How deeply flawed and highly concerning the process by which psychiatric diagnoses are written into the DSM is.
“By reclassifying painful normality as psychiatric abnormality, we have created the illusion of a psychiatric epidemic… At the heart of this illusion sits a book; the DSM. In the early 1970s the DSM had just 106 mental disorders, whereas today there are around 370 disorders”.
Outside of the Drop the Disorder movement, within mainstream culture, we are led to believe that, should a qualified health professional decide that we meet the criteria for a ‘diagnosis’ that:
a) The disorder assigned to us would be a ‘real’ thing based on scientific evidence and biological markers, not just highly subjective descriptions translated into ‘criteria’. And:
b) If we were prescribed medication to help us ‘manage’ said ‘illness’, that the decision to do so would be based on sound medical evidence that the drugs would help, rather than harm us.
The realities are somewhat different, and it is only through the work of those involved in events such as the AD4E festival, that many of us are beginning to know just how different. Via the diagnostic lens, considerations of a person’s experience of safety, connection and of their social context, are sorely missing.
Alternative to Diagnosis
In Dr Lucy Johnstone’s second presentation we learnt about an alternative to Psychiatric diagnosis; the new ‘Power Threat Meaning Framework’ (Johnstone & Boyle, 2019). This offers a fascinating and hopeful way of exploring psychological and emotional distress issues in their relational, social and political environments. “It restores the link between what has happened in someone’s life and the resulting ways we may attempt to survive it” (Johnstone, 2018).
Within this very different approach, there is no external imposition of what is ‘typical’, ‘natural’ or ‘normal’, and there is no authority judging whether our individual responses are ‘disordered’. The Power Threat Meaning Framework offers a supportive way to make meaning of our own lives. Crucially the framework, unlike the diagnostic model, shines a light on the very real impact of power, social injustice and systemic oppression in people’s lives and the need for social action.
Poetry unites the call for change
We heard from many speakers about the extent to which people suffer within the current diagnostic system, about lost years, dehumanising inpatient treatment, medication side effects, stigma and self-stigma. These themes were brought most powerfully to life, as speakers shared their experiences through poetry. As we listened to the emotional landscapes of each poet, we were invited to recognise and connect with our own. As Dylan Thomas said; poetry “helps to change the shape of the universe, helps to extend everyone’s knowledge of [them]self and the world around them.” Together, the poetry provided the most moving and united call for change.
As the event shifted gears and moved into a more relaxed evening session, a much-needed glass of wine beckoned. After listening to all the incredible contributors, I reflected on the many thoughts and feelings that had been stirred inside me. I was left with a deep sense of gratitude, to have been able to spend the day surrounded by the shared narrative that trauma, adversity and oppression do not mean we are ‘broken’, or ‘disordered’. The concluding message was one of validation and recognition that we all deserve more safety, connection, care and compassion, free from judgement and pathologizing classification.
To all at the AD4E team, a huge thank you for an incredible festival and for sharing your experiences so generously.
You can now find many of the presentations from the festival here: