Mental Health Reform is Severely Needed

When I was 14 I was diagnosed with bipolar. I was hospitalized, medicated, and put into therapy. Once I had that label, everything I felt and did was because I was bipolar. My house was very chaotic and violent. My mom ran a sex toy shop and the house was filled with porn and vibrators. There was a constant stream of my mom’s friends and boyfriends, strangers, through our house and through my life. My stepdad (my younger sisters’ dad) had moved out four years prior and ever since it had happened, I’d been reminded by all of the adults in my life that the only man who’d ever been a father figure to me wasn’t actually my dad. Mom was always trying to get me to stay home instead of going to visit him on the weekends with my sisters. She even lied to him several times that I didn’t want to go, then came back to me and said “Jose doesn’t want you to go on Sunday. He thinks it’s weird you want to go. You aren’t his kid.” And then there was the constant screaming, being slapped, kicked, punched, etc. 

But none of that mattered. None of that was explored.

I was bipolar. 

I was given drugs. 

None of the stress and chaos in my life was a factor in my erratic and abnormal behavior. I had a chemical imbalance. 

Under the biomedical model of mental health treatment, social/environmental factors are barely considered. Even when they are considered, they are always secondary to the “brain illness” theory. 

I went to therapy, sure. And a nice Christian woman, who had named both her tropical fish after Biblical figures, would smile and nod while I rambled on about the bands I liked and the kids at school and all the fights I was having with my mom. I let her read my poems once. Many of these were rife with someone-please-notice-my-pain overdramatic suicidal ideation. Back then, I had a fantasy of starving myself to death and I flirted with binging and purging, but never had the discipline to really stick with it. I had vivid daydreams of an open casket funeral where my family would have to stare down at my emaciated form and say, “We shouldn’t have yelled and been mean and hit her. Look at what we did to her.” 

When I was diagnosed bipolar, it felt like I was being told that everything was my fault. I was defective. My brain didn’t work properly. And of course, my family members loved to use the word “bipolar” as a weapon against me. 

None of my feelings were valid. It was like I wasn’t even human anymore. Everything I felt was because of my brain disease. 

I was angry at all of the adults in my life for the physical and emotional abuse and the professionals always seemed to be saying, “All of that is irrelevant. This is a separate issue. Your brain is defective. If your brain wasn’t defective, you wouldn’t even be so angry about all of that.”

Because I felt so entirely dismissed and judged by these professionals, they really only ever heard the tip of the iceberg with the abuse in my house. I tested them, tried to figure out if I could trust them, and when they always circled back to this label, this accusation, I threw my walls up. 

Labels are otherizing. Labels are a judgement. Labels hurt. You can not hurt people and then expect them to let all their walls down and be incredibly emotionally vulnerable with you. Therapy didn’t do anything for me because of this. I wasted a lot of time talking about nothing. Because I was afraid to say anything real. Those professionals kept me so on edge and made me feel so small. 

Now, a lot of the time, when I criticize therapy and talk about the deeply-ingrained systemic issues, well-meaning and kind people who simply have blinders on will argue with me using anecdotal evidence. They talk about therapy helped them or someone they know, and ignore the fact that patient treatment is built on a flawed model from the ground up.

I also have to ask: when people talk about their bad experiences with the police, or talk about ways that policing could be improved, do you pop up to talk about how you or someone you know was helped by the police?

Just because therapy helps middle-class white people with mild mental health issues and resources, that doesn’t mean therapy helps the most vulnerable people: the homeless, the people with psychosis, the low-income and POC patients, and children.

It’s getting very exhausting dealing with people derailing conversations about the systemic problems with therapy to spout anecdotal evidence. Anecdotal evidence very much colored by their socioeconomic status, race, and severity of mental illness.

Back then, I didn’t know exactly why I hated being labeled bipolar so much. I just did. I could admit there were problems with my behavior and I could admit that I struggled to regulate my emotions. I could admit those things and was willing to work on those things. I just didn’t want to be bipolar.

I believe that one word “bipolar” kept all of the doctors, therapists, and mental health professionals who dealt with me from looking any deeper. There was no reason for them to try to figure out why I was angry, why I couldn’t control my emotions, why I was disruptive in class and threatening suicide. There was no reason for them to look for a reason; the reason was a chemical imbalance. So as a teenager, they didn’t help me escape my abusive home situation. They didn’t even give me tools to cope with it. They gave me drugs. With the biomedical model of mental health treatment, drugs are the only logical answer. Drugs are the only hammer worth swinging at a problem believed to be caused by a chemical imbalance. 

Not only do these labels stigmatize, prevent patients from getting to the real of their problems, and lead to the prescription of superfluous drugs which may harm them (the “side” effects produced by SSRIs and antipsychotics lead to an enormous drop in quality of life and may even lead to lifelong disability (akathisia) or death) but to really put the cherry on top, these diagnostic labels may not even be scientifically sound. In fact, there is a plethora of evidence that these labels are not based in scientific fact. 

The book that doctors use to diagnose patients is the Diagnostic and Statistical Manual. The DSM is published by the American Psychiatric Association, which is a lobbying group (. This is the book that doctors use to diagnose psych patients. The DSM has “a nearly hegemonic status as the reference for the assessment and categorization of mental disorders of all types – not only in the United States, but increasingly in Europe and more recently Asia (Kawa).” 

The majority of doctors on the boards of both the DSM IV and DSM V received money directly from pharmaceutical companies. It’s very easy to see how these egregious conflicts of interest directly influence the DSM itself. Allen Francis explains in a Wired interview that the diagnostic labels in the DSM are “making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies (Greenberg).”

Allen Francis was the lead editor of the DSM IV and he admitted that psychiatric diagnosis is about as far from an exact science as it gets. He is actually quoted saying, “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it (Greenberg).” That’s not exactly heartening to hear. Although it’s not very surprising when we remember some of the very normal and healthy human behaviors that have been clinicalized/pathologized in the past. It wasn’t very long ago that homosexuality was one of the labels in the DSM. Yet for some reason, the majority of people don’t question the DSM today. The methods for creating diagnostic criteria haven’t changed much. In one of her many lectures on the topic, Paula Caplan explains that a great deal of creating diagnostic criteria is simply doctors sitting around a table and going with their gut. Premenstrual Dysphoric Disorder was thought up by two men on a fishing trip. They engaged in the facade of research. They created a checklist of symptoms and gave it to several groups of people. One of these groups was a group of men. There was no significant difference in how any of the groups answered these research surveys. Obviously a pre-menstrual illness is not something that cis-men can suffer from. Yet this was ignored, PMDD entered the DSM, and prozac was rebranded as Serafem. Many of the women prescribed this drug with all of its hyper-feminine, pretty pink packaging, never even knew that what they were taking was prozac (Gottstein). 

Using the DSM as their primary guide, mental health professionals look at every patient, not as a human being with complex psychological mechanisms and learned behaviors and coping skills that-while unhealthy-may be reasonable given the context of the patient’s life and past traumas, but instead as a cluster of symptoms. Within the biomedical framework and with the DSM in hand, an adolescent who is angry and acting out is not possibly displaying an appropriate reaction to trauma and a chaotic or unsafe living situation; they are bipolar. Give them a pill. Shut them up. Balance their mood. Teach them they deserve whatever is happening to them and that they are ill if they can’t cope with it. Teach them they deserve abuse. What else would drugging up traumatized children possibly teach them? 

And this doesn’t set children up to move past their trauma in a healthy way. It sets them up perfectly for trauma reenactment as an adult. It is a terribly harmful system. 

There isn’t even enough evidence in favor of the biomedical model to justify using it as the primary framework for mental health treatment. In fact there is a lot of evidence that the chemical imbalance theory, the basis of the biomedical model (and the justification for using all of these diagnostic labels) is entirely wrong. As Irving Kirsch explains in his book The Emperor’s New Drugs: Exploding the Antidepressant Myth, “From the beginning, the chemical-imbalance theory was based on weak and contradictory evidence, and data contradicting it were simply ignored…A half-century of research has produced data indicating that the chemical-imbalance theory must be wrong (Kirsch 82).”

It’s interesting to note that the first antidepressant was invented before the chemical-imbalance theory was ever posited. The first antidepressant was iproniazid. It was created in 1951 for the purpose of treating tuberculosis (Kirsch 83). For whatever reason, whether it was the placebo effect or improved quality of life due to reduced physical suffering, patients in the initial drug trials reported feeling happier and having a greater overall sense of well-being. 

The drug was invented before doctors ever had any idea of depression being caused by a chemical imbalance. I find it highly suspect that a drug was accidentally discovered to have an effect on depression and then a scientific theory of the root cause of depression followed. It is my belief that a profit motive incentivized the creation of the biomedical framework, a framework that greatly harms mental health patients. Ethan Watters explains in his book about the Westernization of mental health treatment worldwide that in countries that use either a spiritual or psychosocial model of mental health, patients have far better outcomes, particularly when it comes to psychotic illnesses such as schizophrenia. He refers to this as the “most perplexing” piece of data we have on schizophrenia, that “people with schizophrenia in developing countries appear to do better over time than those living in industrialized nations (Watters 137).” If we consider how dehumanizing the biomedical model is, this really isn’t perplexing at all. While so many mental health activists bemoan the fact that so many people don’t have access to Western mental health treatments, I’d say they are missing something key: they are missing that Western mental health practices harm more than they help. They set people up to fail. That is why so many patients end up labeled “treatment resistant.” 

My solution to help children with emotional issues is simple: ditch the labels. They harm far more than they help. Identify the behavior itself rather than lumping them into a symptom pool which only exists to meet the profit motive of pharmaceutical companies. 

There is no reason why professionals can’t take the extra time to distinguish individual behaviors and potential antecedents, rather than sloppily throwing a harmful label onto children and funneling them into a system that will teach them they are defective because they reacted to trauma, damage their self-worth, and make it all the more likely they never overcome whatever it is they are struggling with. 

I used to work in a special education program and I’ve seen my fair share of IEPs. An IEP (or ‘Individualized Education Plan’) includes a label. For the program that I worked in, that label was almost always autism, because I worked in a specialized autism program. 

Here are just a few things that were actually said to me by teenagers who had been given the autism label:

“I can’t help it. I have autism” (A child who was being disruptive in class and destroying classroom property).

“I won’t get married when I grow up. I’m autistic.” 

“Are we going to sit with the normal kids on the field trip?”

“I’m not smart. Autistic kids aren’t smart. I didn’t talk until I was eight. I’m stupid.”

I’m somewhat torn when it comes to labels and autism, because many autistic people are proud to be autistic and consider it a large part of their identity. But it would be disingenuous for me to not point out how harmful that label was to the confidence and self-image of many of the kids I worked with. 

I have to think; could we have given them the services and help they needed without a label? 

In public education, the answer is probably no. Everything must be documented to ensure kids receive the help they need and that documentation comes with a label. 

Unfortunately, it means that many kids who do not even fit a label end up being given it, simply so that the school can better meet their needs. In the school I worked in, we had a number of students who needed a more specialized class program. One was a traumatized child who had been kept out of school from some time and bounced from one foster home to another. She was fifteen and could not read. Her IEP included the phrase “autism spectrum disorder”, yet it was an open secret that this girl did not have autism. She simply couldn’t be put into the general education classes, because of both academic and emotional challenges. The label was necessary to get her the individualized instruction she needed. 

So when labels can not be ditched entirely, I think it’s pertinent to treat the children as individuals first and foremost. Treat them as human beings with complex emotional and academic needs. There’s no reason to reduce them to a label (which happens far more than it should, from what I have seen of K12 education). 

There are a few other changes that could be made to K12 education to improve the mental health and emotional well-being, not only of children who have been diagnosed, but of all children. 

I want to take a second to consider the secondary education setting. Kids have somewhere between 5-10 teachers, depending on the school and classes they are taking. Every 40-60 minutes, they get up, collect their belongings, and walk through a maze of crowded and noisy hallways. They have no time for deep learning or reflection. They are in a constant state of transition; class is forever either starting or ending. Eight or nine times a day they are moving through a swarm of bodies, bombarded by noise and nonsense. 

In what other situation would a human being live this way? In elementary school, kids remain in the same classroom for much of the day, maybe leaving two or three times for lunch and special programs. As adults in the workplace, we get to work and for the most part, remain in the same place all day. Even when I worked as a retail cashier, I might have moved from one register to another, but I mostly remained in the same general area. 

We ask middle and high school students to live in a way that is not expected of anyone else. Even in college, students usually have only three or four classes in a single day. Secondary students in K12 education transition almost ten times a day. Some schools have a rolling block schedule that cuts down somewhat on transitions. For the most part though, students are transitioning far too often. They have no time to settle in, to feel connected to their surroundings or build a classroom community. They have limited opportunities to relate to their teacher or find a mentor/role model. They are in a constant state of flux, not truly connected to anything. This isn’t a natural way to spend half of a human being’s waking hours. 

Student mental health could be greatly improved by lumping subjects together (math and science in one cluster, English and history in another) and having the same teachers instruct multiple subjects, so that the students can transition far less often. 

With teachers spending more time with the same students, mental health or behavioral challenges could be identified and dealt with more quickly. 

I’d also like to suggest that when a student is struggling that we don’t rush to get them labeled and funneled into the very harmful mental health system. There is a more human way to help them. Instead of pills that will greatly detract from their quality of life through a combination of lowered self-confidence/self-worth and terrible side effects, why not encourage kids to join clubs, go out for sports teams, or volunteer in their communities?

When I was a teenager, I actually experienced both. I was put on powerful drugs (some of which I now know had the potential to cause me debilitating and even life-threatening side effects) and I volunteered in my community and was active in clubs at school. I took depakote, prozac, and zyprexa, and I also helped out at my local library every Saturday morning. This was in the early 2000s and my library was in the midst of switching from a physical card catalogue to a digital system. My rural NH town had only one librarian and putting every single book into the digital system was time intensive. So I helped out with that. I was also a Big in the Big Brothers Big Sisters program and hung out with a third grade girl every Friday afternoon. Volunteering and writing for my school newspaper kept me busy and was great for my mental health. Much better for my emotional state and sense of self-worth than the pills that gave me tremors and sleep disturbances or the therapy sessions that made me feel unheard and judged. 

Am I saying pysch drugs or therapy are always bad and never work for anyone? No, not at all. But because they have the potential to greatly harm, they should not be the first tool we reach for. There’s a plethora of evidence that funneling a kid into the mental health system will have a negative impact on them for the rest of their life. The mental health system runs on a profit motive, and therefore often marginalizes and harms the vulnerable people it is meant to care for. 

So why introduce children to something potentially harmful, why subcontract basic human compassion? Why label traumatized or struggling children as “chemically imbalanced” and drug them up? 

Why do any of this, when there are so many other compassionate and holistic resources at a school’s disposal?

Humans need community, connection, a sense of purpose, and solid role models to guide them. These are all things that a caring school can provide, without referring children to “professionals.” Those professionals have been corrupted in a number of pervasive and insidious ways by pharmaceutical company money, and so they are likely to put children on powerful drugs, when really all that child really needed was to be heard, understand, and guided towards some positive coping tools. 

Reject labels, or at the very least decentralize them from your understanding of a student. We live in a hyper-individualistic society that loves quick fixes. Reject this. Invest in your students. Have real compassion for them. And when a student is struggling, resist the urge to foist the kid off onto the mental health system. By doing this and fostering a positive and supportive school environment, teachers and administrators can do so much more than a diagnostic label ever could.

Works Cited

‘Financial Statements as of December 2019.’ 2019 IRS Form 990. The American Psychiatric Association, Financial Information. https://www.apa.org/pubs/info/reports/2019-form-990.pdf p. 43. 

Gottstein, Jim. “‘There are No Rules About Psychiatric Diagnosis-And That Must End!’ Paula J. Caplan, NARPA 9/4/14.” Youtube. 4 March, 2015. https://www.youtube.com/watch?v=tgilB… 

Greenberg, Gary. “Inside the Battle to Define Mental Illness.” Wired. 27 December, 2010.  https://www.wired.com/2010/12/ff-dsmv/

Kawa, Shadia, and James Giordano. “A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: issues and implications for the future of psychiatric canon and practice.” Philosophy, ethics, and humanities in medicine : PEHM vol. 7 2. 13 Jan. 2012, doi:10.1186/1747-5341-7-2

Kirsch, Irving. The Emperor’s New Drugs: Exploding the Antidepressant Myth. Basic Books, New York, 2009. 

“Sarafem.” RxList. 29 Dec. 2014. https://www.rxlist.com/sarafem-drug.htm

Watters, Ethan. Crazy Like Us: The Globalization of the American Psyche. Free Press, New York, 2010. 

12 thoughts on “Mental Health Reform is Severely Needed

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  1. very valid arguments here! I don’t entirely agree with it all, for example I have complex mental illnesses, dissociative identity disorder and complex ptsd, and therapy has helped me greatly. But then my therapist is trauma informed, and so is my psychiatrist, so that in itself is a huge blessing. Meds arent always the answer to psych issues, I do agree with that, and I don’t agree in giving kids medication, its harmful and so wrong. xx

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      1. Woot! I figured we were on the same page here.

        A lot of people don’t realize how much influence pharma has over doctors. The most troubling thing is their influence over the DSM. The DSM is the very foundation of psych patient care. These corporations gave money to MOST of the doctors on the board that created the DSM 4 and 5. I find that so inappropriate.

        It amazes me more people don’t speak out against these financial ties. Patients will never get the best care while pharma pays so much money directly to doctors and while pharma funds so much of the research. I don’t understand how that is legal or why there isn’t more of an outcry against it.

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      2. I think that’s why I was diagnosed with bipolar and put on so many drugs, instead of actually helped. Doctors didn’t acknolwedge that I was living in a chaotic and dangerous and situation and that I was having a normal reaction to that.
        This is because during the early 2000s, there was an absolute epidemic of kids diagnosed with bipolar for a profit motive. One of the doctors on the mood disorders panel of the DSM 4 was receiving money directly from Risperdal-a manufacturer of a drug approved by the FDA to treat bipolar in kids. This doctor, receiving money from this drug company, “educated” his fellow doctors on how to spot bipolar in kids AND lobbied to expand the diagnostic parameters of bipolar in the DSM 4. So from about 1999-2005 there was a mass influx of kids diagnosed with a chemical imbalance, many of whom were having a natural human reaction to trauma.

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      3. Our governance is heavily steered by big business interests, sometimes through economic intimidation. To me, it’s as though the elected heads are meant to represent huge money interests over those of the working citizenry and poor. Accordingly, major political decisions will normally foremost reflect what is in the influential corporations’ best interests.

        Furthermore, corporate lobbyists actually write bills for our governing representatives to vote for and have implemented, supposedly to save the elected officials their own time. I believe the practice has become so systematic here that those who are aware of it (that likely includes mainstream news-media political writers) don’t bother publicly discussing it.

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      4. Whenever a federal Liberal government promises Canadians universal generic-brand medication coverage (and such promises on their own are extremely rare here), the pharmaceutical industry reacts with threats of abandoning their Canada-based R&D (etcetera) if the government goes ahead with its ‘pharmacare’ plan. Why? Because such universal medication coverage, generic brand or not, would negatively affect the industry’s plentiful profits. The profits would still be great, just not as great. Meanwhile, we continue to be the world’s sole nation that has universal healthcare but no similar coverage of prescribed medication, however necessary.

        Recouping R&D costs is typically cited by the powerful industry to justify its exorbitant prices and stiff resistance to universal medication coverage public plans, the latter which it’s doing in Canada. However, according to a Huffington Post story (“Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: Report,” updated May 8, 2013), a study conducted by the British Medical Journal found that for every $19 dollars the pharmaceutical industry spent on promoting and marketing new drugs, it put only $1 into its R&D.

        A late-2019 Angus Reid study found that, over the previous year, almost a quarter of Canadians decided against filling a prescription or having one renewed, due to medication unaffordability. Not only is medication less affordable, but other research has revealed that many low-income outpatients who cannot afford to fill their prescriptions end up back in the hospital system as a result, therefore costing far more for provincial and federal government health ministries than if the medication had been covered.

        So, in order for the industry to continue raking in huge profits, Canadians, as both individual consumers and a taxpaying collective, must lose out huge. And our elected representatives, be they federal (neo)Liberals or Conservatives, shrug their figurative shoulders in favor of the pharmaceutical industry — time and again.

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    1. Due to increasingly common privatized research for corporate profit aims, even ‘scientific fact’, to a concerning degree, is for sale. Research results, however flawed, can and are known to be publicly amplified if they favor the corporate product, and accurate research results can be suppressed if they are unfavorable to business interests, even when involving human health.

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    2. The only two health professions’ appointments for which I’m fully covered by the Canadian public plan are the readily pharmaceutical-prescribing psychiatry and general practitioner health professions? Such non-Big-Pharma-benefiting health specialists as counsellors, therapists and naturopaths (etcetera) are not covered for a red cent. Is that just a coincidence? …

      It’s now commonly known that pharmaceutical corporations intentionally pushed their very addictive and profitable opiate pain killers — I call it the real moral crime — for which they got off relatively lightly, considering the resulting immense suffering and overdose death numbers. I find it is not an honorable or moral business but rather rife with corrupt conflicts of interest.

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  2. While progress is being made on this front, for me there’s still too much platitudinous lip-service towards proactive mental illness prevention for men (and even boys), as well as treatment.

    Various media will state the obvious, that society must open up its collective minds and common dialogue when it comes to far more progressively addressing the challenge of more fruitfully treating and preventing such illness in general; however, they will typically fail to address the problem of ill men refusing to open up and/or ask for help due to their fear of being perceived by peers, etcetera, as weak/non-masculine. The social ramifications exist all around us; indeed, it is endured, however silently, by males of/with whom we are aware/familiar or to whom so many of us are closely related. Robin Williams’ suicide comes to mind.

    Even in this day and age, there remains a mentality out there, albeit perhaps subconsciously: Men can take care of themselves, and boys are basically little men. It’s the same mentality that might explain why the book Childhood Disrupted was only able to include one man among its six interviewed adult subjects, there being such a small pool of ACE-traumatized men willing to formally tell his own story of childhood abuse. Could it be evidence of a continuing subtle societal take-it-like-a-man mindset? One in which so many men, even with anonymity, would prefer not to ‘complain’ to some stranger/author about his torturous childhood, as that is what ‘real men’ do? (I’ve tried more than once contacting the book’s author via internet websites in regards to this unaddressed elephant-in-the-room matter but received no reply.)

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