Rumblings in Psychiatry

In a recent Mad in America column Philip Hickey, PhD placed a hickey on Jessica Gold, MD (a resident in psychiatry) with a 10-point denunciation on the demerits of psychiatry, which I will capsulize as follows:

1.  Psychiatry’s definition of mental disorder embraces every significant problem of thinking, feeling, and behaving and thus medicalizes problems that are not medical in nature.

2.  Psychiatry presents illnesses as causes of specific problems, which are merely labels and provide no insight into the nature or essence of the presetting problem.

3.  Psychiatry has routinely deceived us with these vaguely defined problems but have no known neural pathology.

4.  Psychiatry has promoted drugs as corrective measures when it is “well-known” that no psychiatric drug corrects any neural pathology

5.  5. Psychiatry has conspired with big pharma to demonstrate that their products are safe and effective and suppress negative results, short term follow-up, suppress marginal results and suppress revealing of adverse effects.

6.  A great many psychiatrists accepted large sums of big pharma money in various gifts and inducements

7.  Psychiatry’s labels are disempowering by using notions that the “diseases” are incurable and require drugs for life. This encourages long-term dependency and mediocrity.

8.  Psychiatry’s treatments are destructive and damaging in the long term

9.  Psychiatry’s self serving medicalization of mental problems undermines resilience and foster powerlessness, uncertainty, and dependence.

10.      Psychiatry’s primary agenda over the past four decades has been the expansion of the list of mental illnesses and the assignment of these illnesses to more and more people. 

Before addressing these 10 issues by Dr. Hickey, one by one, it should be pointed out that something went way south long ago.

When I entered psychiatry after 10 years as a country doctor in Mississippi I was moving toward the specialty because of the psychiatrist that I brought into Natchez Mississippi gave so many people electric shock treatments(ECT) that he wore out his welcome. I knew I made a mistake when I realized that he did not like to listen to people.  I thought I could do better by just listening, if nothing else. 

Near the end of my life I find that many issues such as mental illness have a historical quality that are ignored because the claims and counter-claims missed the scene of the accident by decades. When psychiatrists discovered that they could get in on the medical insurance bonanza they jumped in with partially hatched and poorly incubated disease labels. But they failed to catch up because the labels were a house of cards. So to this extent I agree with Dr. Hickey on his list of complaints of 1, 2 and 3(seen above). Dr. Hickey has not, however, offered a viable solution as often happens when one arrives on the scene 20 plus years after the accident. It is as though a container ship was built to carry containers that had not been described but only vaguely glimpsed. Most of our severe problems span more than 100 years. not the least of which relates to the phenomena known as spiritual healing (will be discussed more in a later blog).

Points 4 and 5 by Dr. Hickey have been cited in the current issue of Scientific American which is available https://www.scientificamerican.com

And look for

Psychiatrists Must Face Possibility That Medications Hurt More Than They Help

 

Items 6,7,8,9 and 10 point to a issue raised by Malcolm Gladwell called moral licensing . Gladwell explains that moral licensing occurs when one gives themselves permission to act immorally because they feel empowered because they have recently done good things for others as one example. When I was in practice big pharma reps would often comment on how poor people could be help by getting free samples failing say that the drug was cost an arm and a leg as soon as the samples were gone. Gladwell explains that someone told him that they were not prejudiced racially because they had a black friend.

Although I agree with Dr. Hickey on the 10 points he offers no solution. So I contend that there are bottom-up methods of human interaction, which have not come into widespread usage because they require work, and a method of start-up.  

In 1958 we set out to solve the problem of schizophrenia as a post-sophomore research fellow for the National Institutes of Mental Health. Little did I know then and just a wee bit more do we know now. My colleague, Dr. Baringer and I thought we could narrow the focus to the study of a copper-bearing enzyme (ceruloplasmin) thought to be a problem in schizophrenia. Six decades later we still don’t know much about ceruloplasmin and its role in schizophrenia. We did gain a large dose of humility.

When psychiatry began working on the DSM III in 1974 it was not until 6 years later that a finished product was published. The six years was fraught with much gnashing of teeth and a house of cards was waiting to be blown away. Dr. Baringer and I contended in 1958 was that the interactions of personality with biologic and genetic forces did not give an adequate foundation for a medical diagnostics scheme. With the advent of the gene mapping we are left even more out on a shaky limb. Now in 2016 with one in every 6 Americans taking a prescribed medication for a mental health problem we are truly awash in doubt.

In my opinion the major players in the development of the DSM III were the big pharma psychiatrists, the child psychiatrists and a few psychoanalytic psychiatrists who remained alive but could not keep pace with the new order. What needed to be understood was the role of personality in healing from the vagaries of modern life. We needed to understand child development and the role of faulty and/or inadequate development in mental problems. we needed to find methods to emulate natural healing as well as find schemes of spiritual healing. Finally we needed to give space for the emerging arena of genetic factors. It was a tall order abut when the smoke cleared we faced a cosmetic nightmare. 

So we are left with a mess and the probability of the medications that are being promoted by psychiatry are covering up problems in the short run and deepening problems in the long run. Meanwhile eighty years of trial and error in Alcoholics Anonymous coming from the bottom–up rather than the top-down have focused on each person facing their character defects and vowing to make restitution while their group views their progress with empathy. Though painful it appears to work as well now as it did 80 years ago. What the AA scheme does address is the power of our individual genetics to mold our future. The power of AA is to use group support to help each individual cope with their own gene-behavior. Can you imagine for a moment what it would take for Trump to modify his genetic-greed behavior? Now after 34 years in AA I can tell you that modifications come with serious work on my part and serious help from my AA friends and sponsors on their part.The Double Circle Group is but a method in continual trial and error to assist in learning to work with a sponsor, getting the group help to navigate thorny issues of personality, and discovering how to get the most out of bottom-up processing. I favor a kind of sponsorship that depends on the principle of helping each other achieve sobriety and mental well being while gaining a more evenhanded personality. As of this writing many AA sponsors use an autocratic way of sponsorship.

In the past twenty  years AA groups working from the bottom-up have gradually brought into their fold those with a variety of disorders on a person by 
person basis. AA Central Office has only peer related input into this phenomenon. 

From the AA opening meeting statement; "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who will not or cannot give themselves to this simple program......"

The Mystery of the Double Circle Process

 Two years have past without a breakthrough in the interest among my friends and colleagues concerning the Double Circle. Malcolm Gladwell uses the term revisionist history and talking about how events of the past can be seen in the light of present circumstance quite differently than  the circumstance when  this subject was first conceived.  To give you an example the double circle was developed by accident in 1978.  Since then it appears  that some things we never even thought about have come into science and spirituality that brings me to revise my thinking.   From Rupert Sheldrake we are hearing about the field-effect between animals and even plants for that matter.  How do schools of fish and flocks of birds move in unison?  How can we  sense that someone is standing behind us.  Dr.  Sheldrake, who was a biologist, has offered a method for examining the phenomena of flocks of birds and schools of fish and people standing behind us.  But the supportive person Double Circle Group offers a rich soup for further discovery in this area.  Through Gladwell and others we are finding more and more about how we arrive at decisions in his book called Blink.  For example, how does a supportive person manage to assist the person in front of him participating in group interaction in the inner circle?   What does this supportive person need to know?  In rapid group interaction how can they possibly find out about the person they  are supporting?    In these instances  even the mistakes become a rich source of discovery.  Another question might be why have the supported person dyad  anyway.  Of what use is it.   Well, I presume that pairs can learn to  function effectively without much training at all.  As a matter of fact  the pair does not have the sharp ego edges that a single individual has and thus can be more easily digested by the group is large.   But is the pair able  to go beyond the capabilities of a single individual.    Think what this would mean in the workforce.  Rather than hiring one person you hire two people  and your reason is  that they function better than one person.

Some Elements of the Master Plan

 It should be understood that the Double Circle Group is only an instrument or a vehicle for developing bottom-up processing among lower income and destitute folks within shouting distance of Gainesville Florida. Bottom-up processing must be, in my opinion, developed to counter the extreme threat of artificial intelligence, robotic work, advancing technology, and general population increases beyond our means.  With the advent of the huckster as president-elect it should be no mystery that the ground was shaking beneath us.

With that in mind I would like to begin developing a working weekly group process at the Triangle Club in Gainesville.  However, the configuration of the circle or circles is not a primary issue.  What the Triangle Club needs and Alcoholics Anonymous within the Eye-opener Group needs is a better retention of new people coming into Alcoholics Anonymous. I believe Dick and Tom made a great contribution with their step study effort.  This would be a continuation of that effort in a different format. 

I would like to begin is a single circle allowing for crosstalk and aimed at developing a continuing protocol for the group meetings. 

Meanwhile, we have been continuing the Double Circle Group process at Alachua Presbyterian Church.  We now have six members who are coming or regular basis.  We are meeting usually every two weeks.  One of our charges is to develop a workbook for the double circle group process.  The other is to actually conduct the group to discover more ways of achieving some primary aims, which I will list below:

1.   Discover more about the supporting person process through repeated trials and variations in configuration.  For instance, we need to find out whether it is better to maintain fixed membership in a particular circle while changing who is supporting who at regular intervals.

2.   We need to ultimately decide whether there is a fixed protocol.  This would gradually developed by the workbook.

3.   We need to decide whether we are developing facilitators with a fairly exact definition of what a facilitator is and what is required in terms of training.

4.   We need to decide if facilitators are to be compensated once trained.

5.   We need to find the methods for establishing facilitators in particular settings such as the prisons, schools, and other interested groups.

From the Bottom Up

I recently posted on Facebook a short statement about the recent presidential election.  It seems that no matter what we do on the bottom of the top continues to win big and in a “money” system the 1% at the top control the 99% at the bottom.  So how can we shift from a money system?  As I mentioned last week Michael Tellinger says the Ubuntu system of Contributionism is a possible solution.  The problem in such a system is complexity and a lack of cohesiveness.  We need a simple path in which people with drive, skills in ordinary human relations and perseverance can succeed by their efforts in small groups. This past year we wrote a book called The Power of the Double Circle.

By the use of pairs of people working in tandem within a double circle, power is generated and sustained. By power I mean action to solve problems in real time about what in believe we all cherish; that is truth justice and love. In this triad love is the mystical and elusive element, which most group efforts fail to sustain because the human being is in the midst of an evolutionary crisis. This crisis is in the transition from individual ego, which is seen in powerful leaders, to the sense of team or WeGo. By WeGo I mean the effective pair within the double circle operating for the good of both circles. One might critique this to say the pairs can simply begin to act as just another overpowering ego. However, this pairing floats from individual to individual so that the pairing is constantly in flux.  So each person develops a skill to deal with those people he or she may think they are incompatible with by having to change pairing frequently. Each person learns to love what works; passing effortlessly from individual ego to the WeGo state of mind no matter what each person thought of the other’s

personality beforehand. Can we move to a personality of the pair casting aside the sharp edges of each other’s personality?

The Few Society

While in a meeting this morning it occurred to me that the two candidates who were struggling to gain the presidency of the United States were actually in the same camp.  Both are top-down people and are not bottom-up people.  We are moving into a period in our history in which war will seem be less of a problem than the famine used to avoid it.  The wealthy and the privileged will be protected in enclaves. Just two days ago Elon Musk was the first person in public life in forty years that spoke of the real problem we are faced with today.  Neither of the candidates mentioned that there are going to be (in the near future) no jobs for many of Americans as well as many people abroad.  With the oncoming automation, artificial intelligence, and insulated artifacts such as Washington DC most of us outside of that sphere will face extreme poverty and even starvation.  With the survival of the fittest mentality that both candidates seem to have in great abundance we are as bottom-up people faced with a terrible situation.  Both political parties seek to end or curtail seriously what are called entitlements.  But a kinder and more realistic word would be a floor for all to stand on.

The central problem of political reality is that opposing positions are used to create an atmosphere of conflict in which one can win over the other.  But what they fail to demonstrate is that there are some problems that are common to all.  Neither candidate can manage a campaign talking about conflicts that are common to us all.  This could be global warming or too few jobs for too many people. 

The technological improvements are racing ahead much faster than the population's ability to make use of it or service it.  So the net result is that we will end up with many more people than are useful in our society, which is obviously becoming more and more a society of privilege for the few. For the moment I will offer to you to consider a radical departure from the current society designed for a few to a society designed for all. This is  “UBUNTU Contributionism” as outlined in a manifesto by Michael Tellinger called A World Without Money. On Youtube at: 

www.youtube.com/watch?v=4sxwXjqawEw

Beeswax From the Bottom Up

     Our nation is in the midst of a severe and prolonged stripping away of the power of the middle class. In fact many of us will no longer be able to claim membership in the middle class. We find ourselves on or uncomfortably near the bottom.  If we find out how we got to the place then we might be able to figure out how to get out of the bottom.

     A second and related issue is what greased the wheel.  Just out of high school I worked at Ingalls shipyard in Pascagoula and suddenly found myself on the ways crew.  We were responsible for greasing the skid that the 600-foot ship would use to slide the ship into the Pascagoula River. It took a ton of beeswax to grease the skid.  What will it take to swing the welfare of the people on the bottom into a chance to break from the bottom?  What will be the beeswax that moves our country and our people back into prosperity and hope?

     Why beeswax?  A generic article in the Internet says that there are at least 100 uses for beeswax.  But the 100 did not include using beeswax to launch a ship.  So there may be even more.  I was told that beeswax is used to launch ship because it is the lubricant that has the least chance of catching fire during the process.  If you want to begin dialogue by moving from the superficiality of deep discussion,we at least,must realize that when dialogue is approached overheating of the participants is likely.  Rather than catch fire some participants simply pull back and try to cool off.  I am leading up to a method, which helps as beeswax does to keep the process cool enough to be smooth and effective.  In other words if you form circles of people to talk about crucial issues in their lives how do you keep the individual egos from overheating.

     From an unlikely physicist, David Bohm, we are encouraged to develop small groups to go beneath small group discussion into small-group dialogue.  His vision was to stop the fragmentation that we now see in our political process and reach consensus for the common good.  In this 2016 presidential contest we see sharp contrast and nothing but innuendo and assumed moral decay.  The issues are not discussed and we are not in dialogue. Our children are only vaguely noticed. We would know we were in dialogue should we begin to talk about our children and how we are destroying our own planet and ask for forgiveness for calling each other liars. We would know we are in dialogue when we stop talking in political modes and begin to talk in survival modes.     

      As the species Homo sapiens we have just recently broken out of the African continent about 60,000 years ago.  Before that there were many thousands of years in which our ancestors were chimps and apes with much smaller brains.  With the enlarging of our brain about 1 million years ago the species began to emerge from Homo erectus and gradually to Homo sapiens.  We have lost our ability to swing through the trees but we have gained the ability to run and stand upright.  But what we have not done is completely evolve into reasonable loving caring unselfish human beings.  We are now rushing into a period of history in which the acceleration is leaving many people behind without jobs and without support.  If we do not care about these people that are being left behind then war will ensue again. 

Discovery

 I have been caught up in many conflicts in life and now face a conflict as to whether I should impose on the memory of an old friend from Natchez Mississippi.  He has since passed on and I now remain very old and unsure as to what I should be doing at this point in my life.  For the last several years I have been working on a group process.  This group process is aimed at the discovery of a very elemental human situation.  How do two people become so accepting of each other that they, as a pair ,have a force greater than themselves as single individuals?   There is no doubt that human beings communicate very readily in words, but have we lost a more basic nonverbal communication as we have raced through history and language development?  When I first developed the double circle group or supporting personal group it was seemingly too complicated to understand and very uncomfortable for the people participating in it.  But over the years I returned to the time and time again.  There is something mysterious going on in the double circle group which I cannot explain but I am determined to discover and expect to my dying day.  At times I felt a sensation while in the group that gave me reason without rationale, hope without fact, expectation without the slightest evidence that something material could be brought out in this group.

During my 10 years in Natchez Mississippi I came to know Ben Chase Callon.  This man was a mystery to me.  He seemed to jump right out of a Faulkner novel.  He had a way of speaking that almost was entirely metaphorical although I often groped for the metaphor.  As I began to decide to leave Natchez and go into psychiatry I thought he would object.  He helped me build the Morgantown Clinic and had been very supportive of me and my family.  But, in fact, he did not object to my leaving and told me that there was something important that I had to do that I could not do in Natchez.   At the time I just believed that I should go into psychiatry because I had always planned on it since high school.  Even though my family objected strenuously to pulling up roots, I dragged them to Gainesville Florida.  My wife was so upset about leaving that she said she played Beethoven's ninth Symphony over and over again just to ease the pain.  

 The strangest thing about Ben Chase Callon  was that he did not seem to have an ordinary ego. Rather than an ego he seemed to be in constant observation of everyone else in his life.  Over and over again  he spoke to me about the strange things that he would see in those about him which he found amusing.   Although he was a part of a several brother operation in the oil business event never really spoke about the oil business.  He talked about personality and the quirks  that he saw in personality.  I shared his interest in personality and talk to them as much as I could.  Twenty-five years after leaving Natchez and during the midst of my career as a psychiatrist, I return to visit briefly and found Ben Chase Callon there at a party for me hosted by former employees.   Again he told me that there was something important that I was supposed to do.  He did not know what it was but he was certain of it.

After a distressing period of rampant alcoholic fog in Venice Florida,  I sought the help of my long time friend, Bob Baringer, in St Augustine and limped to him for relief. In Venice I totally lost my spiritual rudder. I had also lost sight of Ben Chase Callon. I knew that there was nothing in Venice for us as a family or for me, professionally.

 Bob and I developed a practice down on St George Street in the heart of the touristy section of St Augustine. It was surreal but delightful to be in a session with a psychiatric patient and suddenly have a tourist burst through the door blurting out, " Is this house on tour?"  The patient and I laughed while the tourist sheepishly backed out of the door.  By some quirk of fate or God's blessing Bob and I gathered a men's group together. That men's group brought me to task as to what psychiatry was supposed to be about. Our group was composed of vets of three world wars and  a vet of the most notorious psychiatric hospital in the South.  At times the group unfolded into sunlight as our words failed us. Sometime later I asked myself  again and again."What was that all about?" After all words make up sentences and sentences go together to bring about enlightenment and positive change. But the stunned silences brought us all in the group to cohesion, annealing and finally relief of private pain into a shared bearable one.

So I left this idyllic practice and followed Frieda( my wife) to Gainesville.I decided to return to the University of Florida in the faculty of the Department of Psychiatry. But in a marriage one cannot go on very long with one having boucou of fun while the other sits on the beach. So when my wife decided to return to the University of Florida and find her own niche in the world of  niches. I felt vaguely permitted to tag along.They were desperate for someone who had experience in general medicine, so they welcomed me. Soon after in 1978 I began a new group method at Shands on the 8th Floor which was to become the Double Circle Group 28 years later. She gained a bachelors in psychology and went to work.

  Using my own imagination I assume that the important thing that I was supposed to do was some discovery.  I knew that Ben Chase had  little interest in wealth although he enjoyed a good life but I also knew that he thought there was something to discover in the human personality that was worthwhile.  Since then I have wandered around the state of Florida sometimes in the depths of alcoholism and sometimes in the heights of discovery.   Now at 83 I wonder how to bring this can opener into the light.  

The can opener is the Double Circle Group. This group is a method for discovery of forms of communication that predate the verbal one and may be effective in deepening and clarifying the communication level among people who are feeling the stress of modern life.