>But it’s a particularly cute little rhetorical move by Breggin: whenever a patient claims that medications have helped them and that they’re content with taking them, he simply asserts that those patients have been misled by the effects of medication spellbinding.
Weird how every modern political movement has some equivalent of Marxist false consciousness. For feminists it's internalised misogyny, for anti-racists it's internalised racism, for this guy it's medication spellbinding.
For certain trans activists it’s internalized gender stereotypes…
Standpoint epistemology at its finest, in all cases. A significant orientation of postmodern philosophy’s development has memory-holed society with various forms of false consciousness.
(And please don’t crucify me - I know the aforementioned can be a touchy subject around here, but I am in full support of autonomous bodily agency and categorically against ideological supposition/sophistry, especially when it regards a persons psychology.)
Don't forget the legend of psychologists having taken people's claims of being okay as signs of their being in denial of their illness. I don't know how often reality may have matched the legend. I wonder whether there's a name for it as a rhetorical fallacy.
Not in a therapeutic context, but in a political context Eric Raymond refers to this as "Kafkatrapping" (http://esr.ibiblio.org/?p=2122), which takes the general form of "the fact that you don't acknowledge that you're racist is proof of how racist you are."
"As much as any political tendency I can recall, the anti-psychiatry movement has avoided easy categorization into left or right, drawing adherents from all across the political spectrum, particularly the crunchy environmentalist left and the anti-establishment paranoid right. "
They (we) still assert that, exactly up to the point that anyone suggests mental unhealth in an individual can affect the personality of that individual in a way that is traditionally coded (as much by conservatives as by liberals!) as Bad Person.
I feel like I hear “mental health is health!” a lot, especially online, but usually as part of one of those arguments that some random thing is “actually self-care” in some obscure roundabout way.
Thank you for writing this!! When I peek at mad in america I'm like - yeah it sounds like there's some bad stuff going on in psychiatric practice but uhm you all make it sound like having severe me mental illness is not that big of a deal and if only we had a perfect anticapitalist system there wouldn't be issues which I don't think is the case. Hopefully you can get some articles about this into mainstream publications! Are you aware of any books with good takedowns of these harmful views that provide an alternative to dealing with the legitimate grievances about institutionalization abuses, medication side effects, balancing personal autonomy with needing to deal concerns by family and public safety etc? Or maybe you need to write one. :)
A brilliant analysis from a practicing psychiatric nurse practitioner who takes the this work very seriously and although I am conservative in my prescribing practices I absolutely see the value of both medication and mandated treatments
Psychiatric medication saves lives and restores the self to people who might never have seen their former self again. I guess I'm spellbound by the mighty magicians and witches who study, create and prescribe medication, because I couldn't believe this any more fervently.
Even if it were some sort of placebo effect, it would be criminal to take away what works. However, I know that it's not placebo effect at work. Personally, one medication is effective and the rest are not, and if it were spellbinding (snort) all of them should work, right? I only believe in the great Wizard Bristol-Myers Squibb, all other magicians and witches are hacks, I guess.
Breggin can say what he wants right up to the point of withholding medication, at which point it becomes malpractice and legal action should be pursued.
It's a mystery how everything about mental health has been so thoroughly fucked from every direction. Even when people are paying attention and good-hearted enough to try, it's hard to sort it all out.
A wizard named Squibb? I'm skeptical. I'd watch out for Lord Regeneron, though.
But seriously. Any critique that lumps all psychiatric medications in together is fundamentally unserious. They're about as similar as all the classes of medications you can use to treat cardiac conditions, but if someone said "taking medicine for your heart is bad, it's cardiotoxic and patients only think their chest pains are improving" they'd rightly get looked at crosswise. It's only the moralizing associated with taking psychiatric drugs that unifies the category, and this is the only reason such crude arguments get popular traction.
There are people in my neighborhood who still wear masks outside when walking alone on the beach. I also know people who claim that the reports of any COVID deaths were/are a hoax/conspiracy/scam. And I'm sure there is a whole ecosystem online fueling both of these perspectives.
I remember seeing the internet develop in the 90s and being certain that technology was transformative. I could not have imagined our current fact-optional reality.
Weird. I spent a ton of time last summer in a very liberal beach area and don't recall seeing any masks.
I sometimes wear a mask outside when it's cold out - N95s are perfect for keeping your face warm in the winter wind. I also wear a mask (inside) when I have a cold - not so sick that it makes sense to stay home all day, but sick enough where it's worth taking an easy precaution to avoid spreading germs. In both cases, I suspect there are people scowling at me as crazy.
I think the mask-on-the-beach crowd, almost by definition, avoid going to the beach in the summer when it is crowded. These folks are mostly solo dog walkers.
I also still sometimes wear a mask and folks who scowl about it can eat shit. And if someone wants to wear a mask on the beach, have at it, but that decision doesn't appear to be grounded in a realistic assessment of the potential risks.
My brother and his girlfriend avoid going to indoor restaurants entirely these days due to fear of long COVID. He even masks up to go to the office every day. I think it's all very silly, but it's basically impossible to talk to him about these things.
I'd love to see Freddie cover the mental health establishment on the 60's and before. I suspect the social justice fringe he addresses near the end of his essay might indirectly be responsible for the modern homelessness issue. Electroconvulsive Therapy is vilified, but its typically done with the patient unconscious these days and it cured a good friend of mine of his endless cycles of Major Depressive Episodes. Doubtless some in house facilities were corrupt over the years, but was it as bad as movies or Foucault would lead us to believe? Last year Cody Johnson of Some More News reiterated the notion that people aren't mentally ill, they are just unusual, and labeling them mentally ill helps rein in the rebels. It seems a misfiring of empathy is actually making the vulnerable worse off and has been for decades.
Szasz himself was libertarian and today there are right-wing figures (eg Bryan Caplan) who are also anti-psychiatry and don’t believe in the concept of mental illness. So it’s oddly a cause that spans the political spectrum. I think the only common factor is the ability to ignore reality if it conflicts with your ideological abstractions.
Are you saying that the distance from libertarian to libertarian "spans the political spectrum?" (I'm just unclear what you're saying from the two people you mention in this comment.)
Mad in America is fringe? Them's fighting words, as Yosemite Sam would say. I think they provide a valuable perspective, even if they go too far in rejecting what they see as industry propaganda.
Your work on mental illness is why I subscribe and will continue to do as long as you write. I am so grateful for your strong stance on the reality of mental illness and dangers untreated mental conditions poise to our community. Thank you, thank you.
It is simply not true that there is no neurological or physiological evidence demonstrating mental illness. Not gonna give up my space to anti-psychiatry people, go spread your "I healed myself with crystals" bullshit elsewhere. Banned, and this serves as a warning for the rest of you.
For the record, "I heard of people who killed themselves on Zoloft, ergo Zoloft made them kill themselves" is expressly rejected in this piece as a bit of utterly unscientific nonsense, so you can't say I'm out of line here.
I don't know of a single person who claims to have been healed by "crystals" but there are quite a few of us who found significant symptom relief with dietary changes, with therapy to address childhood trauma and/or the formation of healthy relationships, moderate exercise, sunlight, meditation and mindfulness practices, and plant medicines (in my case, psilocybin and turmeric have done wonders).
How many of you suffer from chronic psychotic disorders that have prompted you to engage in acts of criminal violence? Let me guess - "that's not who I'm talking about!" And this is precisely the problem; I'm not interested in what works for the worried well. I'm interested in what works for the guy who's slowly dying from gangrene under a bridge who won't be saved because he thinks the CIA installs bugs in your teeth when you go to the emergency room.
Sure ... I don't know if I'd characterize myself as "worried well" however, given I was experiencing visual hallucinations, could barely get out of bed, was suicidal, had chronic migraines, and could barely eat at my peak illness, only to get significantly better with the aforementioned (high doses of mushrooms needed). But I also agree that medication can be appropriate when it comes to violent tendencies and mental illness; however, it shouldn't be the first resort when it comes to the majority who are suffering (to whatever extent).
This discussion isn't about the majority. It's about the small number of psychotic who are a danger to themselves and others. This is my nephew. He was emaciated, had third degree burns from lighting a can of gasoline in his bedroom so he could breathe because he was a robot and made out of metal. He left the hospital so he could put those burns in dirt to treat them. He walked around a mall in a ski mask with a knife talking about killing people because the zombies were after him.
There's a big difference between what you describe and what those of us who are advocating for more mental institutions with step-down alternatives and involuntary commitment. It's like shoplifting vs. armed robbery with assault rifles.
I'm a paid subscriber to this substack because I agree with most of Freddie's takes on mental illness, in particular when it comes to extreme mental illness, violence, and the ridiculousness of mental health activism. However, this post included some generalizations, including about ADHD, that I felt were necessary to push back against.
Violent offenders are disproportionately likely to come from single-parent households. This points to a relationship between neglect, abuse, and factors related to lower incomes such as poorer diet.
The severity of schizophrenic symptoms, including hallucinations, has been connected in several studies to alcohol, refined sugar, processed food, and caffeine consumption.
Do some people need psychiatric medications to not be a danger to themselves and others? Yes. Do some people need to be (humanely) locked up to not be a danger to themselves and others? Also yes. But even in these extreme cases, you'll see at least some improvement in symptoms and well-being with improved diet and Vitamin D levels. (I do not recommend psychedelic plants for people with personality disorders or severe mental illness with psychosis, and even the most ardent activists for plant medicines typically agree with this caveat).
“Sure ... I don't know if I'd characterize myself as ‘worried well’ however, given I was experiencing visual hallucinations, could barely get out of bed, was suicidal, had chronic migraines, and could barely eat at my peak illness, only to get significantly better with the aforementioned”
“Worried well” is such a slippery category. Physicians who can’t physically explain a patient’s complaints might dismiss a patient as “worried well” with a referral to psychiatric evaluation if the patient insists on seeking help. Meanwhile, the DSM 5’s “Somatic Symptom Disorder” seemed to be a fancy way of dismissing patients’ physical complaints as those of the “worried well” — even in manifestly ill patients:
The way Freddie uses “worried well” often seems to be purely psychiatric — that is, the usage would classify someone whose mental-health complaints had some extrinsic cause, such as physical illness, as “worried well”. And Freddie has a point that someone who’s merely having a tough time adjusting to physical malaise maybe shouldn’t be a high priority for our already-overburdened psychiatric system to treat.
For example, if “yellow zone” asthma is a suicide trigger for me, maybe what I need is better asthma treatment, rather than gumming up psychiatric resources with an alarming complaint (suicidal ideation) that nonetheless may not signal psychiatric illness of any great severity. Of course, acquiring better asthma treatment would take not being dismissed by physicians as “worried well” for having “yellow zone” asthma — and, once you’re dismissed by physicians as “worried well”, you might not get the monitoring and patient education you need to establish that your asthma is, in fact, still in the “yellow zone”.
I spent years like that, with rheumatic symptoms (and migraines), too, that now have a demonstrable physical explanation. During that time, I overconsumed psychiatric care, but not because I asked to. Instead, our medical system asked *me* to, and since I did want to get better somehow, I complied.
I completely agree with Freddie that many people who are not seriously ill are creating undue burden on struggling healthcare systems -- in particular those who doctor-shop, seek vanity diagnoses, and use said vanity diagnoses as influencer and artist/writer "brands". I didn't do any of these things, I actually have been very reluctant to accept the diagnoses I've been freely given (e.g. bipolar II has been suggested to me by several doctors, but I don't think I meet the diagnostic criteria and always say so ... maybe subclinical bipolar, but I don't need treatment beyond being careful with my diet and lifestyle for it). At my illest, I was pushed to take advantage of mental health resources by basically every healthcare worker I encountered ... but in the end, I figured out how to improve my physical and mental health outside of mainstream medicine (albeit with advice given to me by healthcare workers off the clock), e.g. completely rewiring my brain and resetting my gut microbiome with a crapload of magic mushrooms.
MANY healthcare workers know that magic mushrooms and other psychedelics work for a lot of people ... but aren't allowed to tell patients this. Some only do so if they really trust a patient. I've talked to doctors about this and they've just said "I know but I'll get in trouble if I tell patients" etc.
I'd argue that one of the important reasons to discuss dietary factors, plant medicines, and lifestyle factors is that a significant number of people with health and mental health issues could be helped by these interventions and thus alleviate the burden on the healthcare system, leaving these resources for the more critically ill.
I mean, psilocybin is an extremely powerful psychoactive drug that will certainly finish running the clinical trial gauntlet this decade in various jurisdictions. Who’s arguing against diet, exercise, therapy, nature, and meditation as part of a mental health plan for those who are capable of undertaking them, anyway?
I agree psilocybin is powerful! I hero-dosed multiple times in a row and it basically healed all my chronic gut issues and migraines, and dramatically improved my various mental health symptoms and symptoms related to "autism" and "ADHD". The nice thing about psilocybin over psychiatric drugs is that it's not habit forming or addictive. The downside, I suppose, is that a high dose trip is kind of like getting "Christmas Carolled" (or "It's a Wonderful Life"-ed) and it can be very rough on those who get closer to the Scrooge treatment.
I'm sorry Freddie won't engage with this, because you have some excellent points.
I wrote a very detailed post explaining the link between Western parenting and the history of parenting books in the West and mental illnesses and developmental disorders related to right hemisphere brain dysfunction (the RH is rapidly growing and dominant in the first 3-4 years of life, and stress, dietary factors, environmental factors, and brain injury during this period will disproportionately affect the right hemisphere).
A common cudgel used by the anti-psych movement (for one, the Church of Scientology) is pointing out that electroconvulsive therapy is still being clinically practiced -- which is true -- and painting it as an inhumane and painful operation, which is false. ECT is today done under general anesthetic and after truckloads of informed consent paperwork.
Progressives often conflate ECT with electrical aversion therapy, which is most notorious for its association with gay conversion therapy and has nothing to do with ECT. The popular term "electro-shock therapy" fails to distinguish them and aids in the confusion, and the anti-psychiatry movement has been happy to exploit this fact. A quick search tells me that Breggin has been abetting that, and wrote a whole book on it. Wonderful.
Up until at least the 2010s the NIH was still funding studies of the use ECT to "treat" ASD, Autism... if not other neurological conditions and aversion therapy is still quite normal in ASD "treatment" as advocated by Autism Speaks...
This gets complicated. Of many reasons people mistrust ECT, one is that it has a legitimately sordid history: from the 30's until the first antipsychotics were developed in the 50's, it was the only medical intervention for psychiatric disorders other than a full-on lobotomy, and with this hammer everything looked like a nail. ECT was used on not just depression but also on, well, autism and homosexuality. (This is likely a reason why modern ECT is entangled with gay conversion therapy in the public consciousness, but this isn't just an ECT thing, it's the fact that LGBT was overall pathologized at the time.) But today ECT is used on only five disorders: depression, bipolar, schizophrenia, persistent mania, and catatonia. Depression accounts for the vast majority of cases.
I did find a number of modern references on the use of ECT to treat autism, and this paper seems like a reasonable starting point: Luiselli et al. 2021, "Electroconvulsive Therapy (ECT) for Autism Spectrum Disorder Associated with Catatonia and Self-Injury: a Clinical Review". Right in the title it says that this is not about "treating autism," it is about preventing self-harming behavior in profoundly autistic patients by way of the hypothesis that such behavior is related to catatonia. I'm not an expert and I can't really comment on the quality of this research, but the use of ECT to treat catatonia is evidence-based; it's one of the five conditions I mentioned.
You are correct that electrical aversion therapy is alive, although it seems to be relatively niche, and I've updated my comment accordingly.
You are correct, but this doesn't exactly make people feel better. It's just reinforces the idea that psychiatry, and medical practice in general, has a very long history of utterly terrifying mistakes.
Sure, we've fixed a bunch of them. But what are we doing today that in 50 years we will look back on with horror, the same way we look back at ECT and lobotomies?
I haven't read Breggin's work (though I am familiar with it) ... however, he's far from the only person to make the connection between "ADHD" diagnoses and absent or negligent parenting. Gabor Mate wrote an entire book about this, and it's also an established belief in Ayurvedic medicine; absent or negligent parenting isn't the ONLY cause of ADHD, but the other common causes can also be loosely lumped under "parenting" ... these include poor sleep routine (staying up too late, sleeping in too late), low Vitamin D levels (lack of sunlight and poor diet), diet high in refined sugar and processed food (inflammation and nutrient deficiencies), and excess screen time.
I think psychiatric medication helps a minority of people, but lifestyle changes and natural remedies should be tried first. I suspect a lot of people would see significant improvement in their mental health symptoms if they removed processed foods, refined sugar, and alcohol from their diets, and if they got out in the sun more and got their Vitamin D levels up. There are studies linking Vitamin D deficiency, nutrient deficiencies, and sugar consumption to almost every major diagnosis, including schizophrenia, bipolar disorder, autism, ADHD, depression, anxiety disorders, etc.
He uses case studies to back up his claims, because he's a clinician, not a researcher. It's definitely a weakness in his work, but if you want some scientific rigour, I attempted it here (I explain how stress and neglect affect brain development):
It's well established in literature that stress and loneliness impair the immune system, and stress depletes nutrients and affects brain development. The suggestion that neglect in early childhood can lead to poorer physical and mental health in adulthood shouldn't be controversial.
I'm sorry but I just find your whole approach insanely privileged and annoying. This is everything I've been arguing against for years and years: I don't give a fuck about affluent people who complain about their ADHD or their anxiety. I don't give a fuck! Let them get whatever help they need, fine, go wear a copper bracelet and drink some shark fin soup, get tested for your thetan levels, good for you. I am interested in the way that the severely, chronically ill are minimized in these attempts to "normalize" or "destigmatize" mental illness - minimized because they are so rhetorically convenient, because they clearly need so much more than to chew valerian root or burn sage. The conversation centers the worried well over and over and over again, because the worried well plausibly really can be helped by non-pharmaceutical, non-coercive means. But many people can't be helped without powerful drugs and inpatient treatment. That is just a fact.
I'm one of them. If I go off meds and stay off of them, I will kill myself. And I promise you getting more kale in my diet isn't going to stop that. And your absolute refusal to even countenance the existence of the genuinely, severely psychotic is so incredibly frustrating. I spent weeks in the forensic ward of a state psychiatric hospital. I invite you to try that and see if you come out thinking that getting a little more sleep will fix the people in there.
Freddie, I said in my first comment that medication is appropriate in some cases. And I'm not interested in "normalizing" or "de-stigmatizing" mental illness either.
But it's not just people from affluent families who are helped by certain plants and dietary and lifestyle changes! That's insane to suggest. They certainly have better ACCESS to these things, but the first step to improving accessibility is acknowledging that these things can and do help a lot of people.
I never said "getting a little more sleep" (or any other singular intervention) would do anything. I'm very clearly saying that multiple interventions and multiple dietary changes and natural medicines can work synergistically to produce positive effects. There's no magic bullet, closer to magical cocktails, which are probably at least somewhat unique to each individual.
I'm from an affluent family -- and I definitely agree that access to wealth was a huge factor in my recovery and sustained improvements, not just because I could afford to splurge on medicinal mushrooms and other remedies not covered by health insurance.
However, Gabor Mate makes similar claims (including about psychedelic plants), and his experience is from working with an extremely impoverished, marginalized, and unwell population (Vancouver's downtown eastside). My husband is a clinical counsellor who grew up in a low-income single-mother household, and he believes all this stuff too -- and also tremendously benefitted from the things I mentioned before, including recovering from a serious fentanyl addiction with the help of magic mushrooms. MOST of the people I know who believe in plant medicines are not from affluent households, and I know some people who had some violent (not murderous) tendencies in their youths who swear by plant medicines.
Does it work for everyone? No. No single intervention works for everyone, including various psychiatric medications. But a lot of people are helped by this stuff, regardless of socioeconomic status, and including many people with more serious diagnoses and symptoms.
This is a problem of effect size. Things like diet, vitamins, exercise, and meditation, stress and loneliness and epigenetic effects, are small effect sizes. Some don't replicate. Some are only correlations. Most aren't recommended by clinicians because treatments with small effect sizes with few replicated studies and bad study designs, aren't going to offer relief, or might not work at all. For many of these things, complementing them to traditional medicine helps people "feel" better and come at no cost or risks, so why not? But its a problem when people think that "going outside and cut out dairy" will solve health problems - mental or physical.
Unfortunately, some media outlets love to report single studies with small effect sizes for exciting and novel non-medical solutions that many people find, for ideological reasons, preferrable. Fewer outlets discuss the same, boring, tried and true solutions, and their common pit falls (to which we still don't have perfect solutions) because that's not new "news".
I avoided words like "cure" or "solve" for a reason. I know the effect sizes are small, which is why a multifactorial approach is ideal (and because it's rarely just one cause and different compounds in plants work synergistically, and in many cases if one nutrient level is off, it affects others ... for example, a magnesium deficiency will upset Vitamin D levels which will upset calcium levels -- so in this case, getting more Vitamin D without addressing the magnesium problem isn't going to do much). Loneliness isn't a small effect size, by the way (studies indicate the effect size of loneliness on mental and physical health outcomes is rather significant) but I can't imagine there's very much that healthcare professionals can do about a client's loneliness anyway.
Just wanted to mention that the theory I read years ago is that chronic stress such as experienced in complex PTSD can cause methylation of genes that trigger certain conditions, in particular mental disorders, thereby "turning the gene on." The current scientific opinion is that stress is probably the cause of the epigenetic expression of SMI. It's an interesting google trip...
I've seen Gabor Mate, and do not find him especially compelling. However, I do think the scientific evidence is accumulating that he is at least partially correct.
"DNA methylation, a molecular modification that alters gene expression without changing DNA sequence, can be modified by stressful and socioenvironmental factors,3 and aberrant DNA methylation has been associated with a variety of stress-related neuropsychiatric disorders such as depression,4–7 schizophrenia,8 bipolar disorder,9 and autism.10 Thus, DNA methylation may provide a mechanism through which early life adversity becomes biologically embedded in mental illness. Indeed, accumulating evidence from both experimental and human studies has suggested that adverse childhood experience can induce significant and persistent changes in DNA methylation11 and other epigenetic modifications.12 These stress-induced epigenetic alterations can cause stable changes in the expression of genes involved in the stress regulation system, thereby contributing to neuropsychiatric diseases including depression"
Yes! Thank you for this (and I agree there are issues with Gabor Mate, including that he implies *all* mental illness is a result of childhood trauma, which evidence does not support). This raises an excellent point -- once the developmental and epigenetic trajectories have been adversely affected (by stress, trauma, environmental factors, diet etc), they may not be "reversible" or "healable" (not the best words, but I'm drawing a blank). A lot of the research on stress, trauma, and environmental factors has greater implications for child development, parenting, and for younger people. We still have some neuroplasticity as adults, and our genes can still turn off and on, but not nearly to the same extent, and I sincerely doubt that, for example. a frontal lobe or amygdala that develops abnormally because of factors in childhood and adolescence will every function "ideally" ("normally?") no matter what interventions are introduced in adulthood.
Methylated genes cannot be demethylated, as far as I know, so no...there is no cure. However, medication does often work very well as a treatment. Most treatments have side effects, which is unfortunate. But the cost of substituting basically nothing for treatment of a serious condition is incredibly high.
I don't think anyone should substitute "nothing"! I used psilocybin mushrooms (in high doses) which is pretty darn intense, as well as multiple milder interventions.
> I think psychiatric medication helps a minority of people, but lifestyle changes and natural remedies should be tried first.
Why? Why is vitamin D supplementation* superior to antidepressants? (Or actually, going out in the sun is what you recommend, which is an infeasible way to get a clinically relevant increase in levels for many.) Why are "certain plants" preferable to certain lab produced compounds? Would you feel differently about prozac if it happened to grow on trees? How many lifestyle changes and natural remedies does a person have to try before they have your blessing to use evidence-based medicine**? It's hard not to understand your preference here as a bias for the "natural" that remains unjustified.
Edit: The majority of people I know with serious mental illness do manage their lifestyles as best they can. But they *also* need medicine, and it's offensive to suggest cutting back on sugar can take the place of it, and that appropriate treatment should be delayed until we can give sunlight and exercise the old college try. I would get going on how it's in the very nature of some conditions that the whole diet-and-exercise routine is next to impossible, but I'm trying not to get going.
*results are mixed in clinical trials, incidentally
**evidence for efficacy in treatment, not "linking" things
Well, I suppose because sunlight and plant medicines are typically not addictive or create dependence, unlike psychiatric medications, and various deficiencies and lifestyle factors should be ruled out in mild-to-moderate cases (at least) before introducing medications that someone may be on for their entire lives and which may cause significant side effects. In extreme cases, a multifactorial approach that includes both psychiatric interventions and lifestyle interventions will yield better outcomes than psychiatric medication alone. Furthermore, *certain* plants are preferable because they contain multiple compounds that work synergistically, whereas supplements and lab-created medications typically do not.
Most of the people I know with serious mental illness also are careful with their diets (etc) and have seen significant improvements because of this. However, the majority of "mental health activists" and "neurodiversity activists" online are quite clearly not trying dietary changes and many of them regularly post about their high sugar consumption as well. As well, dietary information is so poor in the United States and the rest of the Western world, many people THINK they are eating healthy when they are not (e.g. people were told to avoid eggs because of cholesterol and to avoid fats, and that's a terrible idea if you want the healthiest brain possible).
I think lifestyle changes are incredibly difficult to enact. And plant medicines and other natural remedies are more difficult to access, with finances being a particular barrier. However, an important first step to improving accessibility and addressing the damage Big Food has done is acknowledging that nutrition and the gut microbiome are critical parts of mental health.
Lots of people, including me, also found that lifestyle and dietary changes helped them get off psychiatric medications they were on (I was on atomoxetine for ADHD and depression).
Edit: Vitamin D supplements are the third best option for Vitamin D. Sunlight is the best, but obviously is not always accessible (I live in a rainforest, so yeah). Dietary sources such as cod liver oil and wild salmon and egg yolks are the second-best.
Sure? Psilocybin works better for a lot of people than psychiatric medications, and unlike psychiatric medications, it's not addictive or habit forming, which is a huge plus. I'm pretty happy to be off ADHD meds, migraine-free, and to have significantly improved gut health and mental health because of them.
Many agencies now draw a distinction between "any mental illness (AMI)" and "serious mental illness (SMI)". SMI is limited to things like schizophrenia, bipolar I, other psychotic disorders, and the most severe cases of depression. Though imperfect I think this is an extremely useful distinction to make.
It seems like you have a perspective on mental illness where SMI is basically a rare edge case, to be treated as an exception that doesn't merit much focus in the discussion of AMI. This seems to be the mainstream perspective. Many other people find this perspective very frustrating because SMI can be so unbelievably harmful that it is qualitatively different, and too important to just treat as an edge case.
I actually think a lot of people with SMI could benefit more from a holistic style of medicine that takes better account of diet and lifestyle factors as well as using traditional plants in some cases. But I don't think this knowledge is going to be appreciated much, until its proponents accept just how severe and difficult to treat SMI can be, and how treatment that fails or even works imperfectly can mean death and disaster.
I think that any thinking that falls along the line of "if we just didn't live this twisted modern life style that we've been tricked into, and instead lived a natural, ancient life with natural food and natural cures, we would be cured of everything," is pretty much always suspect.
Literally nobody said that and I never used the word "cure" for a reason. Sincere question, however, if environmental and cultural factors are not involved, then why are the rates of diagnoses skyrocketing?
Because a great many more people with mild cases are seeking treatment. Situations that would, 10 or 20 years ago, not have merited a diagnosis, are now being diagnosed. Therapy and self-care is popular. Therapy as chronic care is normalized.
I'm not against people seeking help for mild cases and talk therapy. I'm a user myself. (edited for typo)
But I think a great many people overestimate just how ill they were. You may have subjectively felt truly terrible (and its terrible of me to even have to point this out), but if your problem was solved by vitamin D - or maybe it was just having concrete goals and something, anything, to get you up and moving around and planning for the future - then you were never particularly ill. I also think people today have formed outsized expectations for what a good life should look like - there will always be pain, even profound pain - and the expectation that all of this needs to be 100% solved or resolved and transmogrified into deep meaning to move on, strikes me as unrealistic.
I do believe that social media is bad for people's mental health. So there is that.
But skyrocketing since when? What was the golden era when things were better?
I never said anything was solved *just* by sunlight or Vitamin D. In my case, I hero-dosed magic mushrooms multiple times in a row to achieve the desired effects (as well as doing MULTIPLE other things to improve my health). I think there are very few people on the planet who would characterize this as a minor intervention.
>But it’s a particularly cute little rhetorical move by Breggin: whenever a patient claims that medications have helped them and that they’re content with taking them, he simply asserts that those patients have been misled by the effects of medication spellbinding.
Weird how every modern political movement has some equivalent of Marxist false consciousness. For feminists it's internalised misogyny, for anti-racists it's internalised racism, for this guy it's medication spellbinding.
It's a fine rhetorical device that guarantees you're never wrong.
Unfalsifiable, as Freddie notes.
Unrelated but Bloodlines is my favourite video game of all time.
I think the technical term is "Morton's fork." You make sure that opposing statements lead to the same conclusion.
For certain trans activists it’s internalized gender stereotypes…
Standpoint epistemology at its finest, in all cases. A significant orientation of postmodern philosophy’s development has memory-holed society with various forms of false consciousness.
(And please don’t crucify me - I know the aforementioned can be a touchy subject around here, but I am in full support of autonomous bodily agency and categorically against ideological supposition/sophistry, especially when it regards a persons psychology.)
FYI, Freddie has a rule against people bringing up trans stuff in the comments of his articles and has been known to ban people for breaking it.
I’ve seen the fiascos.
Don't forget the legend of psychologists having taken people's claims of being okay as signs of their being in denial of their illness. I don't know how often reality may have matched the legend. I wonder whether there's a name for it as a rhetorical fallacy.
Not in a therapeutic context, but in a political context Eric Raymond refers to this as "Kafkatrapping" (http://esr.ibiblio.org/?p=2122), which takes the general form of "the fact that you don't acknowledge that you're racist is proof of how racist you are."
"As much as any political tendency I can recall, the anti-psychiatry movement has avoided easy categorization into left or right, drawing adherents from all across the political spectrum, particularly the crunchy environmentalist left and the anti-establishment paranoid right. "
Romanticism is what they all have in common.
Not too long ago, you'd hear people on the left say constantly that we need to take mental health just as seriously as physical health.
They (we) still assert that, exactly up to the point that anyone suggests mental unhealth in an individual can affect the personality of that individual in a way that is traditionally coded (as much by conservatives as by liberals!) as Bad Person.
The moral failing explanation is irresistible to some.
I feel like I hear “mental health is health!” a lot, especially online, but usually as part of one of those arguments that some random thing is “actually self-care” in some obscure roundabout way.
Reframing being a selfish jerk as mental health treatment is #appropriation.
They just meant they deserve paid sick days when they're feeling stressed out
Hey Freddie! Can we get an update on the book review contest? Sorry for the irrelevant comment.
The post is written and scheduled for Wednesday morning. Sorry for the delay.
Thank you!
Thank you for writing this!! When I peek at mad in america I'm like - yeah it sounds like there's some bad stuff going on in psychiatric practice but uhm you all make it sound like having severe me mental illness is not that big of a deal and if only we had a perfect anticapitalist system there wouldn't be issues which I don't think is the case. Hopefully you can get some articles about this into mainstream publications! Are you aware of any books with good takedowns of these harmful views that provide an alternative to dealing with the legitimate grievances about institutionalization abuses, medication side effects, balancing personal autonomy with needing to deal concerns by family and public safety etc? Or maybe you need to write one. :)
A brilliant analysis from a practicing psychiatric nurse practitioner who takes the this work very seriously and although I am conservative in my prescribing practices I absolutely see the value of both medication and mandated treatments
Psychiatric medication saves lives and restores the self to people who might never have seen their former self again. I guess I'm spellbound by the mighty magicians and witches who study, create and prescribe medication, because I couldn't believe this any more fervently.
Even if it were some sort of placebo effect, it would be criminal to take away what works. However, I know that it's not placebo effect at work. Personally, one medication is effective and the rest are not, and if it were spellbinding (snort) all of them should work, right? I only believe in the great Wizard Bristol-Myers Squibb, all other magicians and witches are hacks, I guess.
Breggin can say what he wants right up to the point of withholding medication, at which point it becomes malpractice and legal action should be pursued.
It's a mystery how everything about mental health has been so thoroughly fucked from every direction. Even when people are paying attention and good-hearted enough to try, it's hard to sort it all out.
A wizard named Squibb? I'm skeptical. I'd watch out for Lord Regeneron, though.
But seriously. Any critique that lumps all psychiatric medications in together is fundamentally unserious. They're about as similar as all the classes of medications you can use to treat cardiac conditions, but if someone said "taking medicine for your heart is bad, it's cardiotoxic and patients only think their chest pains are improving" they'd rightly get looked at crosswise. It's only the moralizing associated with taking psychiatric drugs that unifies the category, and this is the only reason such crude arguments get popular traction.
It takes far more than to say a belief is a conspiracy to discount the belief in 2024.
There are people in my neighborhood who still wear masks outside when walking alone on the beach. I also know people who claim that the reports of any COVID deaths were/are a hoax/conspiracy/scam. And I'm sure there is a whole ecosystem online fueling both of these perspectives.
I remember seeing the internet develop in the 90s and being certain that technology was transformative. I could not have imagined our current fact-optional reality.
Weird. I spent a ton of time last summer in a very liberal beach area and don't recall seeing any masks.
I sometimes wear a mask outside when it's cold out - N95s are perfect for keeping your face warm in the winter wind. I also wear a mask (inside) when I have a cold - not so sick that it makes sense to stay home all day, but sick enough where it's worth taking an easy precaution to avoid spreading germs. In both cases, I suspect there are people scowling at me as crazy.
They work well during allergy season and the fall "smoke season" too.
I think the mask-on-the-beach crowd, almost by definition, avoid going to the beach in the summer when it is crowded. These folks are mostly solo dog walkers.
I also still sometimes wear a mask and folks who scowl about it can eat shit. And if someone wants to wear a mask on the beach, have at it, but that decision doesn't appear to be grounded in a realistic assessment of the potential risks.
My brother and his girlfriend avoid going to indoor restaurants entirely these days due to fear of long COVID. He even masks up to go to the office every day. I think it's all very silly, but it's basically impossible to talk to him about these things.
I'd love to see Freddie cover the mental health establishment on the 60's and before. I suspect the social justice fringe he addresses near the end of his essay might indirectly be responsible for the modern homelessness issue. Electroconvulsive Therapy is vilified, but its typically done with the patient unconscious these days and it cured a good friend of mine of his endless cycles of Major Depressive Episodes. Doubtless some in house facilities were corrupt over the years, but was it as bad as movies or Foucault would lead us to believe? Last year Cody Johnson of Some More News reiterated the notion that people aren't mentally ill, they are just unusual, and labeling them mentally ill helps rein in the rebels. It seems a misfiring of empathy is actually making the vulnerable worse off and has been for decades.
Szasz himself was libertarian and today there are right-wing figures (eg Bryan Caplan) who are also anti-psychiatry and don’t believe in the concept of mental illness. So it’s oddly a cause that spans the political spectrum. I think the only common factor is the ability to ignore reality if it conflicts with your ideological abstractions.
Are you saying that the distance from libertarian to libertarian "spans the political spectrum?" (I'm just unclear what you're saying from the two people you mention in this comment.)
From Szasz (libertarian) to leftists such as Foucault and the 60s new left mentioned in original comment
Check, I did assume you meant something like that.
Mad in America is fringe? Them's fighting words, as Yosemite Sam would say. I think they provide a valuable perspective, even if they go too far in rejecting what they see as industry propaganda.
check out their forums
Your work on mental illness is why I subscribe and will continue to do as long as you write. I am so grateful for your strong stance on the reality of mental illness and dangers untreated mental conditions poise to our community. Thank you, thank you.
It is simply not true that there is no neurological or physiological evidence demonstrating mental illness. Not gonna give up my space to anti-psychiatry people, go spread your "I healed myself with crystals" bullshit elsewhere. Banned, and this serves as a warning for the rest of you.
For the record, "I heard of people who killed themselves on Zoloft, ergo Zoloft made them kill themselves" is expressly rejected in this piece as a bit of utterly unscientific nonsense, so you can't say I'm out of line here.
I don't know of a single person who claims to have been healed by "crystals" but there are quite a few of us who found significant symptom relief with dietary changes, with therapy to address childhood trauma and/or the formation of healthy relationships, moderate exercise, sunlight, meditation and mindfulness practices, and plant medicines (in my case, psilocybin and turmeric have done wonders).
How many of you suffer from chronic psychotic disorders that have prompted you to engage in acts of criminal violence? Let me guess - "that's not who I'm talking about!" And this is precisely the problem; I'm not interested in what works for the worried well. I'm interested in what works for the guy who's slowly dying from gangrene under a bridge who won't be saved because he thinks the CIA installs bugs in your teeth when you go to the emergency room.
Sure ... I don't know if I'd characterize myself as "worried well" however, given I was experiencing visual hallucinations, could barely get out of bed, was suicidal, had chronic migraines, and could barely eat at my peak illness, only to get significantly better with the aforementioned (high doses of mushrooms needed). But I also agree that medication can be appropriate when it comes to violent tendencies and mental illness; however, it shouldn't be the first resort when it comes to the majority who are suffering (to whatever extent).
This discussion isn't about the majority. It's about the small number of psychotic who are a danger to themselves and others. This is my nephew. He was emaciated, had third degree burns from lighting a can of gasoline in his bedroom so he could breathe because he was a robot and made out of metal. He left the hospital so he could put those burns in dirt to treat them. He walked around a mall in a ski mask with a knife talking about killing people because the zombies were after him.
There's a big difference between what you describe and what those of us who are advocating for more mental institutions with step-down alternatives and involuntary commitment. It's like shoplifting vs. armed robbery with assault rifles.
I'm a paid subscriber to this substack because I agree with most of Freddie's takes on mental illness, in particular when it comes to extreme mental illness, violence, and the ridiculousness of mental health activism. However, this post included some generalizations, including about ADHD, that I felt were necessary to push back against.
Violent offenders are disproportionately likely to come from single-parent households. This points to a relationship between neglect, abuse, and factors related to lower incomes such as poorer diet.
The severity of schizophrenic symptoms, including hallucinations, has been connected in several studies to alcohol, refined sugar, processed food, and caffeine consumption.
Do some people need psychiatric medications to not be a danger to themselves and others? Yes. Do some people need to be (humanely) locked up to not be a danger to themselves and others? Also yes. But even in these extreme cases, you'll see at least some improvement in symptoms and well-being with improved diet and Vitamin D levels. (I do not recommend psychedelic plants for people with personality disorders or severe mental illness with psychosis, and even the most ardent activists for plant medicines typically agree with this caveat).
“Sure ... I don't know if I'd characterize myself as ‘worried well’ however, given I was experiencing visual hallucinations, could barely get out of bed, was suicidal, had chronic migraines, and could barely eat at my peak illness, only to get significantly better with the aforementioned”
“Worried well” is such a slippery category. Physicians who can’t physically explain a patient’s complaints might dismiss a patient as “worried well” with a referral to psychiatric evaluation if the patient insists on seeking help. Meanwhile, the DSM 5’s “Somatic Symptom Disorder” seemed to be a fancy way of dismissing patients’ physical complaints as those of the “worried well” — even in manifestly ill patients:
https://www.psychologytoday.com/us/blog/dsm5-in-distress/201301/bad-news-dsm-5-refuses-correct-somatic-symptom-disorder
The way Freddie uses “worried well” often seems to be purely psychiatric — that is, the usage would classify someone whose mental-health complaints had some extrinsic cause, such as physical illness, as “worried well”. And Freddie has a point that someone who’s merely having a tough time adjusting to physical malaise maybe shouldn’t be a high priority for our already-overburdened psychiatric system to treat.
For example, if “yellow zone” asthma is a suicide trigger for me, maybe what I need is better asthma treatment, rather than gumming up psychiatric resources with an alarming complaint (suicidal ideation) that nonetheless may not signal psychiatric illness of any great severity. Of course, acquiring better asthma treatment would take not being dismissed by physicians as “worried well” for having “yellow zone” asthma — and, once you’re dismissed by physicians as “worried well”, you might not get the monitoring and patient education you need to establish that your asthma is, in fact, still in the “yellow zone”.
I spent years like that, with rheumatic symptoms (and migraines), too, that now have a demonstrable physical explanation. During that time, I overconsumed psychiatric care, but not because I asked to. Instead, our medical system asked *me* to, and since I did want to get better somehow, I complied.
I completely agree with Freddie that many people who are not seriously ill are creating undue burden on struggling healthcare systems -- in particular those who doctor-shop, seek vanity diagnoses, and use said vanity diagnoses as influencer and artist/writer "brands". I didn't do any of these things, I actually have been very reluctant to accept the diagnoses I've been freely given (e.g. bipolar II has been suggested to me by several doctors, but I don't think I meet the diagnostic criteria and always say so ... maybe subclinical bipolar, but I don't need treatment beyond being careful with my diet and lifestyle for it). At my illest, I was pushed to take advantage of mental health resources by basically every healthcare worker I encountered ... but in the end, I figured out how to improve my physical and mental health outside of mainstream medicine (albeit with advice given to me by healthcare workers off the clock), e.g. completely rewiring my brain and resetting my gut microbiome with a crapload of magic mushrooms.
MANY healthcare workers know that magic mushrooms and other psychedelics work for a lot of people ... but aren't allowed to tell patients this. Some only do so if they really trust a patient. I've talked to doctors about this and they've just said "I know but I'll get in trouble if I tell patients" etc.
I'd argue that one of the important reasons to discuss dietary factors, plant medicines, and lifestyle factors is that a significant number of people with health and mental health issues could be helped by these interventions and thus alleviate the burden on the healthcare system, leaving these resources for the more critically ill.
I mean, psilocybin is an extremely powerful psychoactive drug that will certainly finish running the clinical trial gauntlet this decade in various jurisdictions. Who’s arguing against diet, exercise, therapy, nature, and meditation as part of a mental health plan for those who are capable of undertaking them, anyway?
I agree psilocybin is powerful! I hero-dosed multiple times in a row and it basically healed all my chronic gut issues and migraines, and dramatically improved my various mental health symptoms and symptoms related to "autism" and "ADHD". The nice thing about psilocybin over psychiatric drugs is that it's not habit forming or addictive. The downside, I suppose, is that a high dose trip is kind of like getting "Christmas Carolled" (or "It's a Wonderful Life"-ed) and it can be very rough on those who get closer to the Scrooge treatment.
I'm sorry Freddie won't engage with this, because you have some excellent points.
I wrote a very detailed post explaining the link between Western parenting and the history of parenting books in the West and mental illnesses and developmental disorders related to right hemisphere brain dysfunction (the RH is rapidly growing and dominant in the first 3-4 years of life, and stress, dietary factors, environmental factors, and brain injury during this period will disproportionately affect the right hemisphere).
https://thecassandracomplex.substack.com/p/the-dangers-of-reading-too-much-part-df8
Bravo! Freddie, you must feel so drained after pulling all of this information together for us. I too subscribe for these articles.
A common cudgel used by the anti-psych movement (for one, the Church of Scientology) is pointing out that electroconvulsive therapy is still being clinically practiced -- which is true -- and painting it as an inhumane and painful operation, which is false. ECT is today done under general anesthetic and after truckloads of informed consent paperwork.
Progressives often conflate ECT with electrical aversion therapy, which is most notorious for its association with gay conversion therapy and has nothing to do with ECT. The popular term "electro-shock therapy" fails to distinguish them and aids in the confusion, and the anti-psychiatry movement has been happy to exploit this fact. A quick search tells me that Breggin has been abetting that, and wrote a whole book on it. Wonderful.
Up until at least the 2010s the NIH was still funding studies of the use ECT to "treat" ASD, Autism... if not other neurological conditions and aversion therapy is still quite normal in ASD "treatment" as advocated by Autism Speaks...
This gets complicated. Of many reasons people mistrust ECT, one is that it has a legitimately sordid history: from the 30's until the first antipsychotics were developed in the 50's, it was the only medical intervention for psychiatric disorders other than a full-on lobotomy, and with this hammer everything looked like a nail. ECT was used on not just depression but also on, well, autism and homosexuality. (This is likely a reason why modern ECT is entangled with gay conversion therapy in the public consciousness, but this isn't just an ECT thing, it's the fact that LGBT was overall pathologized at the time.) But today ECT is used on only five disorders: depression, bipolar, schizophrenia, persistent mania, and catatonia. Depression accounts for the vast majority of cases.
I did find a number of modern references on the use of ECT to treat autism, and this paper seems like a reasonable starting point: Luiselli et al. 2021, "Electroconvulsive Therapy (ECT) for Autism Spectrum Disorder Associated with Catatonia and Self-Injury: a Clinical Review". Right in the title it says that this is not about "treating autism," it is about preventing self-harming behavior in profoundly autistic patients by way of the hypothesis that such behavior is related to catatonia. I'm not an expert and I can't really comment on the quality of this research, but the use of ECT to treat catatonia is evidence-based; it's one of the five conditions I mentioned.
You are correct that electrical aversion therapy is alive, although it seems to be relatively niche, and I've updated my comment accordingly.
I was waiting for someone to pull up the Scientologists.
You are correct, but this doesn't exactly make people feel better. It's just reinforces the idea that psychiatry, and medical practice in general, has a very long history of utterly terrifying mistakes.
Sure, we've fixed a bunch of them. But what are we doing today that in 50 years we will look back on with horror, the same way we look back at ECT and lobotomies?
I haven't read Breggin's work (though I am familiar with it) ... however, he's far from the only person to make the connection between "ADHD" diagnoses and absent or negligent parenting. Gabor Mate wrote an entire book about this, and it's also an established belief in Ayurvedic medicine; absent or negligent parenting isn't the ONLY cause of ADHD, but the other common causes can also be loosely lumped under "parenting" ... these include poor sleep routine (staying up too late, sleeping in too late), low Vitamin D levels (lack of sunlight and poor diet), diet high in refined sugar and processed food (inflammation and nutrient deficiencies), and excess screen time.
I think psychiatric medication helps a minority of people, but lifestyle changes and natural remedies should be tried first. I suspect a lot of people would see significant improvement in their mental health symptoms if they removed processed foods, refined sugar, and alcohol from their diets, and if they got out in the sun more and got their Vitamin D levels up. There are studies linking Vitamin D deficiency, nutrient deficiencies, and sugar consumption to almost every major diagnosis, including schizophrenia, bipolar disorder, autism, ADHD, depression, anxiety disorders, etc.
Gabor Mate has conspicuously failed to produce any rigorous scientific evidence justifying his theory of addiction https://theconversation.com/gabor-mate-claims-trauma-contributes-to-everything-from-cancer-to-adhd-but-what-does-the-evidence-say-207144
He uses case studies to back up his claims, because he's a clinician, not a researcher. It's definitely a weakness in his work, but if you want some scientific rigour, I attempted it here (I explain how stress and neglect affect brain development):
https://thecassandracomplex.substack.com/p/the-dangers-of-reading-too-much-part-df8
Erica Komisar discusses the same thing and goes into brain development and neuroscience, if you prefer.
It's well established in literature that stress and loneliness impair the immune system, and stress depletes nutrients and affects brain development. The suggestion that neglect in early childhood can lead to poorer physical and mental health in adulthood shouldn't be controversial.
I'm sorry but I just find your whole approach insanely privileged and annoying. This is everything I've been arguing against for years and years: I don't give a fuck about affluent people who complain about their ADHD or their anxiety. I don't give a fuck! Let them get whatever help they need, fine, go wear a copper bracelet and drink some shark fin soup, get tested for your thetan levels, good for you. I am interested in the way that the severely, chronically ill are minimized in these attempts to "normalize" or "destigmatize" mental illness - minimized because they are so rhetorically convenient, because they clearly need so much more than to chew valerian root or burn sage. The conversation centers the worried well over and over and over again, because the worried well plausibly really can be helped by non-pharmaceutical, non-coercive means. But many people can't be helped without powerful drugs and inpatient treatment. That is just a fact.
I'm one of them. If I go off meds and stay off of them, I will kill myself. And I promise you getting more kale in my diet isn't going to stop that. And your absolute refusal to even countenance the existence of the genuinely, severely psychotic is so incredibly frustrating. I spent weeks in the forensic ward of a state psychiatric hospital. I invite you to try that and see if you come out thinking that getting a little more sleep will fix the people in there.
Freddie, I said in my first comment that medication is appropriate in some cases. And I'm not interested in "normalizing" or "de-stigmatizing" mental illness either.
But it's not just people from affluent families who are helped by certain plants and dietary and lifestyle changes! That's insane to suggest. They certainly have better ACCESS to these things, but the first step to improving accessibility is acknowledging that these things can and do help a lot of people.
I never said "getting a little more sleep" (or any other singular intervention) would do anything. I'm very clearly saying that multiple interventions and multiple dietary changes and natural medicines can work synergistically to produce positive effects. There's no magic bullet, closer to magical cocktails, which are probably at least somewhat unique to each individual.
I'm from an affluent family -- and I definitely agree that access to wealth was a huge factor in my recovery and sustained improvements, not just because I could afford to splurge on medicinal mushrooms and other remedies not covered by health insurance.
However, Gabor Mate makes similar claims (including about psychedelic plants), and his experience is from working with an extremely impoverished, marginalized, and unwell population (Vancouver's downtown eastside). My husband is a clinical counsellor who grew up in a low-income single-mother household, and he believes all this stuff too -- and also tremendously benefitted from the things I mentioned before, including recovering from a serious fentanyl addiction with the help of magic mushrooms. MOST of the people I know who believe in plant medicines are not from affluent households, and I know some people who had some violent (not murderous) tendencies in their youths who swear by plant medicines.
Does it work for everyone? No. No single intervention works for everyone, including various psychiatric medications. But a lot of people are helped by this stuff, regardless of socioeconomic status, and including many people with more serious diagnoses and symptoms.
This is a problem of effect size. Things like diet, vitamins, exercise, and meditation, stress and loneliness and epigenetic effects, are small effect sizes. Some don't replicate. Some are only correlations. Most aren't recommended by clinicians because treatments with small effect sizes with few replicated studies and bad study designs, aren't going to offer relief, or might not work at all. For many of these things, complementing them to traditional medicine helps people "feel" better and come at no cost or risks, so why not? But its a problem when people think that "going outside and cut out dairy" will solve health problems - mental or physical.
Unfortunately, some media outlets love to report single studies with small effect sizes for exciting and novel non-medical solutions that many people find, for ideological reasons, preferrable. Fewer outlets discuss the same, boring, tried and true solutions, and their common pit falls (to which we still don't have perfect solutions) because that's not new "news".
I avoided words like "cure" or "solve" for a reason. I know the effect sizes are small, which is why a multifactorial approach is ideal (and because it's rarely just one cause and different compounds in plants work synergistically, and in many cases if one nutrient level is off, it affects others ... for example, a magnesium deficiency will upset Vitamin D levels which will upset calcium levels -- so in this case, getting more Vitamin D without addressing the magnesium problem isn't going to do much). Loneliness isn't a small effect size, by the way (studies indicate the effect size of loneliness on mental and physical health outcomes is rather significant) but I can't imagine there's very much that healthcare professionals can do about a client's loneliness anyway.
Just wanted to mention that the theory I read years ago is that chronic stress such as experienced in complex PTSD can cause methylation of genes that trigger certain conditions, in particular mental disorders, thereby "turning the gene on." The current scientific opinion is that stress is probably the cause of the epigenetic expression of SMI. It's an interesting google trip...
I've seen Gabor Mate, and do not find him especially compelling. However, I do think the scientific evidence is accumulating that he is at least partially correct.
"DNA methylation, a molecular modification that alters gene expression without changing DNA sequence, can be modified by stressful and socioenvironmental factors,3 and aberrant DNA methylation has been associated with a variety of stress-related neuropsychiatric disorders such as depression,4–7 schizophrenia,8 bipolar disorder,9 and autism.10 Thus, DNA methylation may provide a mechanism through which early life adversity becomes biologically embedded in mental illness. Indeed, accumulating evidence from both experimental and human studies has suggested that adverse childhood experience can induce significant and persistent changes in DNA methylation11 and other epigenetic modifications.12 These stress-induced epigenetic alterations can cause stable changes in the expression of genes involved in the stress regulation system, thereby contributing to neuropsychiatric diseases including depression"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113110/#:~:text=DNA%20methylation%2C%20a%20molecular%20modification,4%E2%80%937%20schizophrenia%2C8%20bipolar
Yes! Thank you for this (and I agree there are issues with Gabor Mate, including that he implies *all* mental illness is a result of childhood trauma, which evidence does not support). This raises an excellent point -- once the developmental and epigenetic trajectories have been adversely affected (by stress, trauma, environmental factors, diet etc), they may not be "reversible" or "healable" (not the best words, but I'm drawing a blank). A lot of the research on stress, trauma, and environmental factors has greater implications for child development, parenting, and for younger people. We still have some neuroplasticity as adults, and our genes can still turn off and on, but not nearly to the same extent, and I sincerely doubt that, for example. a frontal lobe or amygdala that develops abnormally because of factors in childhood and adolescence will every function "ideally" ("normally?") no matter what interventions are introduced in adulthood.
Methylated genes cannot be demethylated, as far as I know, so no...there is no cure. However, medication does often work very well as a treatment. Most treatments have side effects, which is unfortunate. But the cost of substituting basically nothing for treatment of a serious condition is incredibly high.
I don't think anyone should substitute "nothing"! I used psilocybin mushrooms (in high doses) which is pretty darn intense, as well as multiple milder interventions.
> I think psychiatric medication helps a minority of people, but lifestyle changes and natural remedies should be tried first.
Why? Why is vitamin D supplementation* superior to antidepressants? (Or actually, going out in the sun is what you recommend, which is an infeasible way to get a clinically relevant increase in levels for many.) Why are "certain plants" preferable to certain lab produced compounds? Would you feel differently about prozac if it happened to grow on trees? How many lifestyle changes and natural remedies does a person have to try before they have your blessing to use evidence-based medicine**? It's hard not to understand your preference here as a bias for the "natural" that remains unjustified.
Edit: The majority of people I know with serious mental illness do manage their lifestyles as best they can. But they *also* need medicine, and it's offensive to suggest cutting back on sugar can take the place of it, and that appropriate treatment should be delayed until we can give sunlight and exercise the old college try. I would get going on how it's in the very nature of some conditions that the whole diet-and-exercise routine is next to impossible, but I'm trying not to get going.
*results are mixed in clinical trials, incidentally
**evidence for efficacy in treatment, not "linking" things
Well, I suppose because sunlight and plant medicines are typically not addictive or create dependence, unlike psychiatric medications, and various deficiencies and lifestyle factors should be ruled out in mild-to-moderate cases (at least) before introducing medications that someone may be on for their entire lives and which may cause significant side effects. In extreme cases, a multifactorial approach that includes both psychiatric interventions and lifestyle interventions will yield better outcomes than psychiatric medication alone. Furthermore, *certain* plants are preferable because they contain multiple compounds that work synergistically, whereas supplements and lab-created medications typically do not.
Most of the people I know with serious mental illness also are careful with their diets (etc) and have seen significant improvements because of this. However, the majority of "mental health activists" and "neurodiversity activists" online are quite clearly not trying dietary changes and many of them regularly post about their high sugar consumption as well. As well, dietary information is so poor in the United States and the rest of the Western world, many people THINK they are eating healthy when they are not (e.g. people were told to avoid eggs because of cholesterol and to avoid fats, and that's a terrible idea if you want the healthiest brain possible).
I think lifestyle changes are incredibly difficult to enact. And plant medicines and other natural remedies are more difficult to access, with finances being a particular barrier. However, an important first step to improving accessibility and addressing the damage Big Food has done is acknowledging that nutrition and the gut microbiome are critical parts of mental health.
Lots of people, including me, also found that lifestyle and dietary changes helped them get off psychiatric medications they were on (I was on atomoxetine for ADHD and depression).
Edit: Vitamin D supplements are the third best option for Vitamin D. Sunlight is the best, but obviously is not always accessible (I live in a rainforest, so yeah). Dietary sources such as cod liver oil and wild salmon and egg yolks are the second-best.
Magic mushrooms are a psychoactive drug. You combine a healthy lifestyle with drugs. The fact that it’s from plants doesn’t make it special.
Sure? Psilocybin works better for a lot of people than psychiatric medications, and unlike psychiatric medications, it's not addictive or habit forming, which is a huge plus. I'm pretty happy to be off ADHD meds, migraine-free, and to have significantly improved gut health and mental health because of them.
Many agencies now draw a distinction between "any mental illness (AMI)" and "serious mental illness (SMI)". SMI is limited to things like schizophrenia, bipolar I, other psychotic disorders, and the most severe cases of depression. Though imperfect I think this is an extremely useful distinction to make.
It seems like you have a perspective on mental illness where SMI is basically a rare edge case, to be treated as an exception that doesn't merit much focus in the discussion of AMI. This seems to be the mainstream perspective. Many other people find this perspective very frustrating because SMI can be so unbelievably harmful that it is qualitatively different, and too important to just treat as an edge case.
I actually think a lot of people with SMI could benefit more from a holistic style of medicine that takes better account of diet and lifestyle factors as well as using traditional plants in some cases. But I don't think this knowledge is going to be appreciated much, until its proponents accept just how severe and difficult to treat SMI can be, and how treatment that fails or even works imperfectly can mean death and disaster.
I think in the case of serious mental illness, a combination of approaches is the best strategy! I tried to make that clear in my various comments.
I think that any thinking that falls along the line of "if we just didn't live this twisted modern life style that we've been tricked into, and instead lived a natural, ancient life with natural food and natural cures, we would be cured of everything," is pretty much always suspect.
Literally nobody said that and I never used the word "cure" for a reason. Sincere question, however, if environmental and cultural factors are not involved, then why are the rates of diagnoses skyrocketing?
Because a great many more people with mild cases are seeking treatment. Situations that would, 10 or 20 years ago, not have merited a diagnosis, are now being diagnosed. Therapy and self-care is popular. Therapy as chronic care is normalized.
I'm not against people seeking help for mild cases and talk therapy. I'm a user myself. (edited for typo)
But I think a great many people overestimate just how ill they were. You may have subjectively felt truly terrible (and its terrible of me to even have to point this out), but if your problem was solved by vitamin D - or maybe it was just having concrete goals and something, anything, to get you up and moving around and planning for the future - then you were never particularly ill. I also think people today have formed outsized expectations for what a good life should look like - there will always be pain, even profound pain - and the expectation that all of this needs to be 100% solved or resolved and transmogrified into deep meaning to move on, strikes me as unrealistic.
I do believe that social media is bad for people's mental health. So there is that.
But skyrocketing since when? What was the golden era when things were better?
I never said anything was solved *just* by sunlight or Vitamin D. In my case, I hero-dosed magic mushrooms multiple times in a row to achieve the desired effects (as well as doing MULTIPLE other things to improve my health). I think there are very few people on the planet who would characterize this as a minor intervention.