Day 4
"The results of randomized controlled trials (RCTs) often fail to translate effectively to clinical practice due to several inherent limitations. RCTs are typically conducted over short durations with homogenous client populations that do not reflect the diversity and complexity of real-world patients."
"In addition, the manualization of therapy—a rigid protocol developed for consistency in RCTs—can be detrimental in clinical settings. This approach diverts resources from more flexible, long-term therapies that offer depth and insight, potentially worsening outcomes."
"Moreover, there is insufficient research on the long-term outcomes of routine care."
"The primary outcome was the treatment response rate, which they defined as a 50% symptom reduction."
"In sum, they found “hardly any indications that the outcomes of usual care control groups have improved over the years. In almost all analyses, we found that response rates, remission rates, and SMDs have remained stable over the years.”"
"Additionally, not only is this study important for recognizing the need for implementing and disseminating adequate interventions, but it also calls into question current diagnostic methods and research approaches for depression, leaving room to ponder alternative etiologies and consider social and cultural factors that may influence depression."
- Current psychiatric methods are ineffective for long term, lack insight, and are rigid. Reversing this statement, psychiatric methods would improve if they were long-term oriented, focused more on listening, and were more flexible.
Source:
https://www.madinamerica.com/2024/05/new-study-reveals-stagnant-depression-outcomes-in-clinical-trials-over-time/A story from a mental ward: "When the Help Becomes Part of the Problem"
"I spent my days crying — if not crying, I was thinking about how my presence in space and time was inherently burdening others. Not to mention, I was failing all my classes, and my GPA for my first semester of college was a measly .5 on the 4.0 scale. I was a failure."
"I was to be escorted to one of the hospitals surrounding the university by a young police officer."
"Carlos," - the police officer, - "picked me up from Mr. Ramirez’s office after I had confessed to being a harm to myself publicly — in front of a pair of human eyes and ears, which, to me, seemed to have been made by a deity that insisted on my degradation. I had confessed my sins aloud, and I felt better."
" Initially, I was a bit bemused. “Do all police cars not have cushions on the back seats?”"
"As he fastened himself in, I could see a smirk appearing from the right corner of his thick brownish-pink lips; he chuckled and said jokingly, “Criminals should be comforted on their way to jail now, eh?” A contorted smile appeared on my face, and we went off."
"Carlos was with me for the entire duration of the check-in. He left shortly after."
The nurse has "finally addressed me as I waited near the front of the emergency room. “She’s claiming to be suicidal. Can you take her vitals and then take her down to Crisis for an eval,” he ordered a subordinate. My vitals were taken, and everything came back okay."
"After that interaction, my backpack, electronics, cell phone, and everything else were confiscated. I only had the clothing on my body, a folder, and a book. I was then given a final moment to talk to my parents on the hospital phone before I was placed in the Crisis ward."
"The unit resembled a detention center. All ten cells that outlined the U-shaped corridor were constructed out of white-painted cinder block, plexiglass, and bolts. The beds within the rooms were fused to the floor; a thin mat served as a mattress, and paper served as bedding. As I made my way into the view of the four people in a cubicle that seemed to be a CCTV control room, I noticed at least ten monitors displaying scenes from inside patients’ cells."
"During the evaluation, a nurse with a piercing gaze approached me. She was wearing royal blue scrubs and a white silicon wedding band. She came into my unit and began to ask me questions. “So, what’s wrong? Are you sure you aren’t just having a bad day? You know, sometimes I have bad days where I feel like nothing is working out.”"
"On my short walk to the lavatory, I finally peered into the rooms of my neighbors and saw bodies that resembled corpses. They lay perfectly straight in the cinder block cells. A few hours earlier, one fellow had caused a disturbance and was subsequently put in a straitjacket. I remember him the most. During my four-day stay, there was a woman who came in accompanied by multiple police officers. While being detained, she yelled the slur, “NI****,” to the officer directly in front of her. This was before spitting at her. Thankfully, a bed in Inpatient became available that night, and I finally left Crisis."
"My stay was a prolonged one. During my first night in Crisis, I was given pills to fall asleep and pills to stabilize my mood. This continued throughout my stay. I saw a psychiatrist once every day. I knew after seeing her, it would be another 24 hours until I’d see her again. I remember our meetings being short and curt. She would enter my cell with a few papers stacked on a clipboard. Our conversations began with the typical small talk. “How are you?” “The cafeteria has fresh oranges today. Would you like any?” During those moments I felt the most human. Unfortunately, those moments were short-lived; she would swiftly and awkwardly begin inquiring about the psychotropics I had been given.
“Are you having trouble falling asleep? Is the medication working?”
She asked about when I first began having suicidal thoughts. I told her that they would sometimes flit through my head during stressful periods between the ages of eleven to sixteen. It wasn’t until COVID that they became longstanding. She ended the conversation by telling me that I could ask the staff for more sleeping medication if I needed it and that she’d see me the following day. I was not introduced to any form of counseling during my stay.
They put me in a wheelchair, although the only damaged part of me at the moment couldn’t be physically touched. I was then sent upstairs to the inpatient unit."
"I roomed with a Portuguese woman who was diagnosed with bipolar disorder. The staff believed she was going through a manic episode. I just assumed she was extra chipper despite the circumstances. From what I gathered from her limited English, she had a dog and a son. She spoke of them fondly; she provided sunshine to my days. Life seemed to rush through her veins."
"I did not take a shower during my nearly two-week stay out of fear of being sexually assaulted in the communal space. This fear became even more real after a female patient accused a male nurse who oversaw the showering space of being a Peeping Tom."`
"Later on, I met with another psychiatrist who officially gave me my label: Major Depressive Disorder. I was deeply relieved to receive a diagnosis. The thought that something, beyond myself, was interfering with my ability to bear the weight of my own existence was liberating. I could let myself off the hook for at least some of my shortcomings.
After receiving my diagnosis, I was put on Sertraline (Zoloft), which made me extremely nauseous."
"I was discharged on December 14, 2021, but remnants of myself are still lingering around the hospital. My experience saved my life, but it wasn’t the medications that did it."
"I have been to countless therapy sessions attempting to deconstruct the feelings of dehumanization into digestible morsels... ...I’ve spent many nights talking to individuals on online forums who have had worse experiences in psychiatric wards than I. Tales of individuals forcibly isolated during panic attacks, being sexually assaulted in multiple-occupancy rooms, having to be at the mercy of lengthy waitlists, and being restrained for being ‘non-compliant’ to treatment."
"A few months after first taking Lexapro I quit and was better for it. This was after battling my way through spells of fatigue during my lectures. Although I was not suicidal anymore, I could not function at a standard I was happy with due to mental fuzziness. After quitting medication and simply receiving counseling I came to enjoy life without feeling mentally barren or subdued. I was able to utilize the coping skills I had learned during therapy to sustain myself through perceived failures and inadequacies. What has helped me the most did not reside within a pill bottle. It was finding radical self-acceptance."
I apologize for sending another story about a sad tale. I know I've sent enough, and I know that some people actually read this. Still, this is useful to know for all those who never knew of a mental ward.
(Note: A lot of minor details were cut for length, such as "feelings" and anything irrelevant to the hospital stay (such as reading a book))
Source:
https://www.madinamerica.com/2024/05/when-help-becomes-part-problem/"Over the years, I have seen that many with early traumatization have different experiences of spirituality in their life—something that I feel the secular, bio-medical approach has difficulty responding to. But even social work and psychotherapy can have difficulty allowing these lived experiences. The experience is that, for the vast majority, spirituality is something that instills hope, meaning, and the strength to move on and relate to suffering."
"Half (or more) of those I meet, state in conversation that they have an inner relationship with a spirituality that they experience as helping and supporting in various ways. This despite the fact that approximately 80 percent of Swedes distance themselves from religion (Stiernstedt, 2020). The Swedes, on the other hand, answer yes to the question of whether they believe in a higher life force, and there they rank higher than other Europeans. For many Swedes, there is a difference between religion and spirituality and how it is expressed in everyday life (Stiernstedt, 2020)."
"Roxburgh & Evenden (2016) have shown that clients often do not talk about transpersonal experiences in therapy, as they are afraid of being treated as if they are crazy—a fear that is unfortunately not unfounded. Timander (2021) describes a woman who has a transpersonal experience of Love that fills her and how she was diagnosed with psychosis within Swedish psychiatry. Whitney (1998) is a doctor and has shared his spiritual crisis: “I felt a deep transformation of the meaning of everything that had happened in my life. I was receiving assurances from Heaven itself that I needed to feel ashamed no longer, that I was loved for eternity. Everything that existed was holy. Angels were everywhere, beautiful and terrifying” (p. 1547). He was hospitalized and medicated and told that this psychosis was something he would have to live with for the rest of his life, a biological abnormality."
- The problem.
"Whitney describes that his salvation was to find a private psychiatrist who gave his experience a different narrative; spiritual emergency. Evans & Read (2020) believe that the spiritual crisis contains both psychological material and spiritual experiences and is therefore a “psycho-spiritual” crisis. They believe that it often comes in two phases. First, the breakthrough where the person becomes like a stranger in society and gains access to another world; then a crisis phase where the psychological and traumatic content is processed and integrated."
- The solution.
A snippet for spiritual help, unedited:
"Marit
I am sitting with Marit, 40, who was exposed to violence and abuse within her family throughout her upbringing. After a few sessions, Marit began to tell about her contact with angels, something that came to her at a young age spontaneously. She tentatively tried first and said something short in passing, which I caught and lingered on, opening the door for her to share this story as well. She describes how when she was little she lay in bed and heard her parents screaming and fighting. In these moments of terror, she had sometimes disappeared into a Light that for her was warm and safe. In the Light there were angels and they said they were always with her, no matter what happened. She describes it as when she feels their presence, the anxiety stops and she becomes completely still inside, she gets to rest and she can feel confident. It is for her a sacred experience that has given her a contact with an inner space that is only hers. Like a light that is in her life at the same time and next to the pain. Without it, I wouldn’t have been able to live, says Marit.
This is a description I have encountered several times, where spirituality is unproblematic to incorporate into everyday life. But still important to be able to put into words, as they are often afraid of being described as crazy. A bright secret next to the dark secrets of violence and abuse."
More on the same topic:
"“In particular, it appears that some processes involved in spiritual coping might induce deep psychological changes” (p. 11). Körlin (2007), who is a psychiatrist, describes it as psychotic experiences with spiritual elements; spiritual crises can result in improved functioning and they usually have a shorter course."
"We, as therapists, do not need to take a position on a metaphysical reality or not. The important thing is that we do not medicalize transpersonal experiences as morbid, since in many cases they are actually helpers, a rescue and, for the person, an actual experience."
"In my master’s thesis in social work, I interview nine professionals in care and social care about how to best treat and help people in a crisis with transpersonal elements (Rosén, 2023). It is clear that there is no manual-based “one size fits all” approach, but that the important components are a safe relational approach, a non-medicalizing narrative such as “spiritual emergency”, stabilization of symptoms (preferably without medication), help in sorting out the psychological content, and processing past traumas and life events, while naming the spiritual as real and meaningful."
quote:
In a Mad Studies perspective, we can create a space for another narrative within the dominant secular paradigm. The Mad Studies perspective is a relatively new field that wants to take human experiences seriously and include those with lived experience in research and knowledge (Rodéhn, 2020; Beredsford, 2013). Mad Studies gives space to the life story, trauma knowledge, and the human right to define transpersonal experiences as meaningful—without them being met with skepticism and a medicalizing approach such as loneliness, psychosis and madness. Mad Studies emphasizes “the importance of a change in Western society and how we relate to people who experience deeply human, meaningful and so-called ‘unusual’ states of being” (Timander, 2019, p. 167). To make room for these experiences within a professional conversation, we will have to start with ourselves:
As a therapist, what do I bring with me into the relationship with the other?
What is my paradigm, my value base, what is my relationship to transpersonal experiences?
Can I seek guidance or training to learn more?
Carrington (2017) describes it as a mindful stance in work, where we constantly need to reflect on ourselves and how our interpretive framework affects the person we meet. In Whitney’s (1998) words; “If I had accepted the medical model of my experience, I would not have survived to tell this tale. Despair would have consumed me” (p. 1548). |
quote:
Glossary
Transpersonal theory highlights that we are more than our person, that there is a spiritual/spiritual dimension in existence and man (Cunningham, 2022).
Transcendence. Corneille & Luke (2021), describe transcendence as a spiritual awakening where ego boundaries are dissolved and ordinary and everyday experience is transcended. These experiences include both an embodied sensation and a transcendence and expansion of bodily boundaries, for example merging with “God” or a universal consciousness (Winter & Granqvist, 2023).
Medicalization means that our language has become psychiatric and our everyday understanding of suffering today is given medical explanations (Burstow, 2013; Svenaeus, 2014) We are permeated by a medical culture, where science has taken over to answer questions of meaning and that existential suffering is medicalized and seen as sick . Biological psychiatry ignores the individual’s social context and difficult life events as the cause of suffering (Svenaeus, 2014).
Spiritual crisis / spiritual emergency is a concept within transpersonal psychology and is used to describe a “psycho-spiritual” crisis (Evans & Read, 2020). The term was coined by the psychiatrist Stanislav and his wife Christina Grof who, through their lived experience, created a theoretical framework and methods for dealing with these people, not as psychotic, but as experiencing extreme mental states, levels of consciousness and spiritual experiences (Grof & Grof 1989).
Mad studies as a perspective wishes to challenge the dominant discourses and ideologies that contribute to the dominant biomedical model. At the same time as wanting to expand the possibility that people’s experiences and expressions regarding mental and emotional states are different and should also be allowed to be so (LeFrancois, Menzies & Reaume, 2013). And this also includes transpersonal experiences (Tenney, 2022). |
Source:
https://www.madinamerica.com/2024/05/medicalization-transpersonal-experiences/More on hell, on earth:
quote:
It was May 21st, 2019, when I woke up in a strange hotel-like room drenched in sweat, fully clothed with a winter jacket on and feeling absolutely terrible. Next to me on the nightstand were six plates of food wrapped in cellophane and above me stood a massive, muscular Nigerian man named Henry who explained to me that I was at a drug rehab in Thailand and that I had slept for 48 hours. He had kept bringing me meals for the past two days and had been very worried about my heart rate, he explained. When I was able to fully grasp the situation I was in, a feeling of overwhelming panic immediately set in. It was not a desperate need for narcotics I felt, but exclusively the fear of not having access to my Lyrica and Zyprexa, the immediate cessation of which I had come to fear more than death itself. |
quote:
What I needed was metacognitive therapy and a mentor, but the cult of psychiatry was insistent that the solution to all my problems could be found in psychiatric drugs alongside made-up diseases and labels. I tried many of their useless so-called “medicines,” but in 2011 I ultimately ended up on Lyrica and Zyprexa alongside nine diagnoses. I was told that these drugs had the same dependence profile as ibuprofen (that is, none), and so I figured, “Well, it can’t hurt.”
Eight years later I had become a raging drug addict. By 2019 my daily regimen was 7 grams of cocaine, 320 mg oxycontin, 10 mg Xanax, 120 mg Elvanse, 400 mg modafinil, 5 grams of cannabis, testosterone injections, somatropin, ketamine nasal spray, psilocybin (for depression), MDMA, copious amounts of alcohol and whatever else I could get my hands on. I was working full-time as a professional stand-up comedian with my own travel show on MTV, doing five shows a week with 200 travel days a year. No one ever accused me of being high or being unruly or unprofessional until the last few months before going to rehab. This was simply the cocktail that was necessary for me to survive what Lyrica and Zyprexa did to me. |
Psychiatry: Doctors gave you this medication because they evaluated the risks and figured that the benefits outweight the risks. Keep in mind that plenty of people take medications but do not experience side effects from medication.
"When I woke up at rehab that early summer day of 2019, my number one priority was to get to a psychiatrist to get my psych drugs and avoid going into withdrawal, which was constantly lurking. I had to keep the “kill switch” from kicking in. Henry took me to the best psychiatrist in Thailand who proudly and arrogantly proclaimed in his delusional aura of self-importance and wisdom that the smartest thing to do in my situation was to quit both Lyrica and Zyprexa at the same time, cold turkey. When I protested, he became more and more insistent about his brilliant cold turkey plan and explained to me that the seven valium pills he had given Henry would make it so that I wouldn’t even notice coming off the Lyrica and Zyprexa.
As with all psychiatrists I had met in my life, it was terrifying to see how detached from reality this man was as I watched him feel so superior to me based solely on his belief in the medical model. However, based on experience I knew that as long as I pandered to his ideology, I could get my way. The protocol with these people is always the same: list your diagnoses, praise the psychiatric drugs, and praise them. I ended up getting what I wanted, the Lyrica and Zyprexa; and so I could just focus on getting clean and sober from narcotics for now, keeping withdrawal symptoms from the psychiatric drugs at bay."
"I had lost all hope of coming off these psychiatric drugs years ago, and since it felt like they were slowly killing me, my rational conclusion at the time was that assisted suicide or resuming narcotics were my only two options moving forward."
"When I googled “How to come off Zyprexa,” the top search result was: “Don’t ever start!” Information is the most valuable currency in the tapering game, and when it came to Zyprexa, there was none."
- The problem
The solutions... are not described in the article. Instead, I got a link to a youtube channel:
https://www.youtube.com/@AndersSorensen
"We wanted to make a counterweight and an antidote to both the ignorance dominating the mental health system and the horror stories dominating large parts of the peer support community."
Research his youtube channel, those who have more patience than me.
A bit of personal story, but what helped me taper off drug is an advice from the legendary book called "Dark Templar Saga" from StarCraft book series. In it, it talked about protoss fanatics hooking up a girl with hardcore drugs, and the solution was to wait out the withdrawal in a company of friends. Who'd know that videogames can save lives? (Yeah, the advice has helped me when I suffered through something similar.) Mainly, I could feel safe when I was going through a panic attack, and I could let my brain and body sort the thoughts out, while others make sure I don't hurt myself.
If possible, check out this video, at the very least:
It's the only video I checked.
Source:
https://www.madinamerica.com/2024/05/how-learned-safely-taper-off-psychiatric-drugs/
