ABOUT THIS BLOG -- I was once a writer published the old fashioned way. I am trying to relearn that skill after 15 years of silence, exploring a topic that many are scared to explore. Seeking or being involuntary placed in mental health treatment creates a stigma for the patient -- no matter how strong or trustworthy that patient was before treatment, they are somehow deemed weak and untrustworthy. In my 30 years of psychotherapy and 15 years of silence, I've observed that should something go wrong between clinician and patient, the clinician gets the benefit of the doubt. There are advocates and organizations that are supposed to counterbalance this tendency, but I feel even they are flawed. This is a blog about my journey.

“Q&A: He’s studied mental illness for 50 years. Here are all the things we’re doing wrong: a portrait of professor Andrew Scull” by Thomas Curwen; and my commentary thereof

 The following article titled, “Q&A: He’s studied mental illness for 50 years. Here are all the things we’re doing wrong: a portrait of professor Andrew Scull” was published at the Los Angeles Time's website. I retrieved it May 11, 2022 at 1:39PM EST and I submitted it to archive.org on May 11, 2022 at 1:43PM EST.

If you would like to read the article without my commentary, please click the link above. If you want to read my commentary, keep reading. The text of the original article is in regular font. My feedback is in italics.


"The history of mental illness - and its treatment - is not for the faint of heart.

And modern mental illness - and its treatment --- is? It appears the dynamic that fueled the errors of yesterday, fuel the errors of today.

"From ice-water plunges to the early days of electroshock therapy, from lobotomies (honored with a Nobel Prize in 1949) to Thorazine catatonia, its treatments belong to the pages of a dark dystopian novel. Often targeting the poor, the indigent, the most vulnerable, the attempted cures were cruel, unethical and often racist.

Yet the history demands to be understood.

Yet these "modern methods" need to be questioned. I am getting the impression that the last 15 years of my life - of everyone's life - has a name, and like electroshock treatment, was once deemed illegal. Now, if I could only remember some the names for it. Perhaps someone can mention that name or somehow give me a clue. Things, whose legal status is questioned, have a long reputation of being cruel, inhumane, ineffective, if not downright damaging. Those administrating these methods are, at the extreme least, often frowned on. Would either the interviewer or interviewee inform us what it's name is or is the patient supposed to invest in hundred of books and make a lifetime vestment to figure it out? Hm, a wasted human life forced into locking horns?

"The author of numerous books that delve into human psychoses and their treatments, Andrew Scull graduated from Oxford University in 1969 and arrived in America not long after the Community Mental Health Act of 1963 began to shutter hundreds of custodian institutions around the country.

"Community health centers and treatment programs were meant to fill in that void by providing education and job training for the intellectually disabled. Yet today's crises in homelessness and mental health make clear that these goals were either never achieved or simply abandoned.

Yes, for both the intellectually challenged and the student on the National Dean's List, who has won awards from department chairs because of their writing. But dontcha know - housing felt I didn't know how to read or something because they felt I did not understand a paragraph in their pamphlet.

"Scull's work was initially driven by one simple question: "Why did society imagine that institutionalizing people was so important, and why was so much capital - intellectual and financial - devoted to this end?"

One word: greed.

"The search for an answer made Scull, a professor of sociology and science studies at UC San Diego, a singular authority on more than 200 years of the medical profession's tangled relationship with mental illness. In delineating this history - from asylums to psychopharmacology - he considers the challenge that individuals with mental illness pose for the health of a modern society.

I encourage you to read my blog. I don't own a firearm to shoot it 127 times in a year. I descend from a firefighter, I have no interest or use in house fires. A burnt down house is no longer a home.

"Yet he knows how solutions are elusive and still far out of reach.

Sir, please, come off your high horse. I beg you.

"What impresses me most," he said, "is how recalcitrant mental illness is, how difficult it is to comprehend, how hard it is to come up with effective treatments and ultimately, how it is best to be honest about what we don't know, so we can pursue a more eclectic approach to treating it and not be certain we know the right answer."

I guess simple things like ethics and compassion are difficult for the clinician.

"In his latest book, "Desperate Remedies: Psychiatry's Turbulent Quest to Cure Mental Illness," out this month, Scull is especially critical of the last 20 years when research narrowed its focus onto possible biological factors for mental illness. The lack of concern with the social and psychological dimensions of mental disturbance, he argues, has precipitated inequities in treatment and led to the consignment of the mentally ill to the streets and jails of this country.

I guess there is a biological factor why a clinician or politician would physically lunge at someone who is, within bounds of the law, questioning them. Because the violence that result when ethics and policy are disrespected is merely a chemical imbalance, and we need to involve more people in a what will turn it into a violent stalemate?

"The interview with Scull has been edited for length and clarity.

"Over the last 20 years, the plight of the mentally ill has become most conspicuous among those who are living on our streets. Is it time to declare that the community-based treatment model is a failure? What do you believe are the first steps we need to take in order to begin remedying the tragedy we see just outside our doorstep?

Do we deem community based treatment is a failure? Well, if you want homelessness, yes. Especially in an era where the poor need to rely on Craigslist to find affordable housing.

"We need look no further than our jails and the gutters of our streets to view what the failures of contemporary mental health policy have wrought. The emptying out of asylums without any serious consideration of what was to replace them has contributed to problems of the homeless and the sidewalk psychotic that are now part of the fabric of our cities.

So are you going to justify what I experienced with some strange psychopathic logic? Or are you going to shield yourself with the diagnostic manuals?

"We ought to recoil from arrangements that condemn helpless and suffering human beings to homelessness and prison and stop pretending that chemistry is the sole and singular way forward. Those afflicted with serious forms of mental illness have been cast into the wilderness - a brutal and often fatal outcome for many with few resources of their own. These are people who lack the capacity to function in an environment where they are seen as a drain on the public purse. Chronically dependent on the not-so-tender mercies of a shrinking welfare state, they are doubly stigmatized: for their illness; and because they show few signs of reform or recovery.

You said it. But I will also point out with the prospect of returning to work while brutally ill and more insane than I started, the clinician, and their preferred patients, are also very much a drain on the public purse.

"If matters are to improve, we need to develop a multifaceted approach to understanding and dealing with the problems posed by serious mental illness. This requires a major commitment to housing, supporting and sheltering people who are incapable, for the most part, of providing for themselves. It means serious engagement with research about the best ways to provide these services. Families often find these burdens impossible to bear, and in other cases, patients flee their families. In either case, the alternatives are grim.

Yes, serious engagement to research on the part of the clinician and the patient, so hopefully we can avoid the serious engagement of research on part of politicians, lawmakers and lawyers; correct? The voluntary outpatient has rights - we still qualify under 'consent of the governed.'

"Stop pretending that chemistry is the sole and singular way forward." This is at the heart of your critique of Thomas Insel, who directed the National Institute of Mental Illness from 2002 to 2015. Can you explain your argument? And what approach would you recommend its current director, Joshua Gordon, take?

"Thomas Insel is busy promoting his new book, which carries the odd title of "Healing: Our Path from Mental Illness to Mental Health." It is a curious endeavor, given that his 13 years in charge of the nation's mental health research produced such uniformly dismal results. That's not my opinion. It's his.

Yes, their new books... mhmm *folds arms*

"When Insel stepped down as director of NIMH in 2015 he gave an interview about his accomplishments, after spending by his estimate $20 billion. "I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that ... I don't think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness."

What an interesting place for an ellipses. I contacted the Department of Homeland Security when someone committed suicide in a second-to-last ditch effort to make CERTAIN people wake up! It didn't do anything. I had to take it to the Internet to make it calm down. I had to make my PERSONAL problems PUBLIC to even try to get anything done. Dontcha think that's a bit much to ask? And wow - 20 billion dollars would pay for a lot of independent housing and work training.

"Karla Finocchio, 55, tears up as she talks about being a homeless woman on the streets, Monday, Jan. 24, 2022, in Phoenix. Finocchio is one face of America's graying homeless population, a rapidly expanding group of destitute and desperate people 50 and older suddenly without a permanent home after a job loss, divorce, family death or health crisis during a pandemic.

"Actually, the situation is even worse than this implies. People with serious mental illness live, on average, 15 to 25 years less than the rest of us, and that gap seems to be widening, not narrowing. While genetics and neuroscience have flourished within the confines of universities, their therapeutic payoff has been minimal or nonexistent.

Yes, the entire community, city, county, so forth appears to survive 15-25 less years.

"I'm a sociologist, so you may think I'm biased. Perhaps I am, but in my judgment, Insel's fixation on biology and biology alone has been a profound error. It threatens to undermine the prospects for progress in the mental health arena.

Mhmm... *folds arms*

"Unfortunately, it is the same approach that seems to dominate the thinking and priorities of his successor at NIMH, Joshua Gordon. Gordon is a neuroscientist whose own work, focused on neural activity in mice, and his appointment indicates that the federal research enterprise will double down on neuroscience and genetics.

Yes, if the poor are to survive we are often referred to as 'a mouse.' Mhmm...

"That's a lot of time and money with little to show for it. Surely other voices are calling for a new approach.

Mhmm...

"Increasing numbers of psychiatrists, particularly those now entering the profession, are beginning to voice their discontent and dismay with the direction the profession has taken over the last four decades. That may prove a more potent source of pressure to change current priorities. But within academic psychiatry, as opposed to clinicians who work in the trenches, change is likely to prove harder to come by.

Clinicians are clinicians. They are the they at this point for me. Whether they work in an office, in the trenches, behind a computer (esp. in this Covid age), whether they claim to work for the system, or against it. Are you saying you want the patient to risk our freedoms to clearly specify who or what the problem is? Sounds like baiting to me.

"Careers in academic medicine are built on grant moneys and publications, and those have dried up for psychosocial research. It would take a brave psychiatrist to push against the status quo when the money and prestige that medical school administrators crave and rewards continue to flow toward scientists trying to find a biological link to the disease. Perhaps we shall at some point see the breakthroughs these folks have been promising us for years. Or perhaps these are once more soon-to-be dishonored promissory notes.

Or we leave it to the patient to risk themselves to figure out. They mock the patient - oh, the patient is arguing that getting everything they ever wanted is bad. No, I am arguing over getting a blatant mockery and bastardization of what was NEEDED. So perhaps I should mock right back? Or am I going to be put away for that?

"Your book, "Desperate Remedies," focuses on the psychiatric profession, but we all bear responsibility. Despite the prevalence of mental illness, it still lies in the shadows, marginalized and stigmatized. What are we so afraid of? Why is it so difficult to acknowledge and so easy to ignore?

Yes, more references to books you will make a profit from. I have not found mental illness that it is easily ignored. There is another person trying to take a stand about the mental health system in my little city. They recorded their interactions. I darn well know people aren't level-headed enough to listen because they start watching their videos with the mindset that this person is crazy. If taken out of the context that they are crazy instead of taking the  crazy's words out of context, the videos reveal the patient was NOT in the wrong. And neither am I.

"Mental illness haunts us, frightens us, and fascinates us. Its depredations are the source of immense suffering and not just for the mental patient. The havoc caused by depression, mania, and schizophrenia extends its tentacles to the family of the sufferer, and usually to the community at large.

De-predations? Wow - a very vague word considering some of the schools of thought used in modern psychotherapy.

"Mental illness challenges our assumption that we share a commonsense universe. It injects uncertainty and often menace into our lives. It threatens on both a symbolic and a practical level the fabric of the social order. It is incomprehensible, and deeply disturbing, and we tend to respond by avoiding and stigmatizing those who suffer from it.

I agree with the last 13 words.

"That stigma adds to the pain of those experiencing mental disturbances, often renders family members silent, and even extends its reach to those who claim to treat it. Psychiatrists are among the least respected medical professionals, and shrinks are a routine target of jokes about their competence and even their own mental stability.

At this point, I doubt it is the stigma or of being branded with mental illness that makes my family silent. It is not the judgment of the common man that makes that stigma so terrible, it's the judgment of people like you.

"These attitudes are deep-seated and hard to erase. The problems they create are exacerbated by how pernicious mental illness is. The needs of people with mental illness are great, but in the competition for public resources, they are poor advocates for themselves, and the plight of their families generates only token sympathy from many. In the competition for resources, they are heavily handicapped, and in hard times, mental health budgets are routinely targeted for cuts.

Mhmm...

"Research, searching for the cause of mental illness, is often divided by the nature-versus-nurture debate: Either we are born with a predisposition for the disease, or is it acquired in the course of private trauma. You recommend that we abandon these lines of inquiry. Why?

Or powerful versus powerless debate. Or abuser versus abused debate.

"I'm convinced that madness cannot be divorced from the cultural, social, and psychological matrix within which human beings exist. To deny that social and psychological factors play a major role in the genesis and course of mental illness is to blind ourselves to a mountain of evidence, epidemiological and otherwise, that teaches us that the environment powerfully matters.

It also cannot be divorced from ethics or policy...

"Treating the biological and the social as separate entities is profoundly misguided. To an extent unparalleled in any other part of the animal kingdom, humans' brains continue to develop post-natally in ways heavily conditioned by the environment. Culture and society, on both a grand and a microscopic scale, interact powerfully with our lifestyle choices and our biology, and the physical structure and functioning of our brains are shaped by psychosocial and other sensory inputs. Human neuroplasticity extends far beyond childhood.

Mhmm *fold arms*

"To think of the brain as an asocial or pre-social organ is thus deeply mistaken. So too is the crude parallel notion that mental illness - the breakdown of our cognitive and emotional life - is just brain disease. That said, I would be astonished if it turns out that biology has no role to play in the origins of many major forms of mental illness. To dismiss any role for biological factors is to don a different set of blinkers. One self-imposed blindness is as bad as the other.

Yes, self-imposed blindness is bad.

"The treatment of mental illness has often been worse than the disease. Is this the case of best intentions going tragically awry? Why do you suppose psychiatry's attempts to cure mental illness have been so lacking in humanity?

No, this isn't a case of best intentions gone awry - this is the case of the worst intentions going awry; there is a big difference. And for the second question, well, you said it.

"Mental illness has forced psychiatry to wrestle with profoundly difficult matters. As my history shows, the intractable nature of the disease and the desperation of the afflicted has often proved a toxic combination, an invitation to therapeutic experimentation and excess.

I have not seen the clinician, and yes that is the word I will use until it is safe for me to post names, wrestle with anything except a patient. From my observation, they are self-important and feel the need to be viewed as Gods. As for the second sentence, you said it.

"It is true many treatments added to the suffering of the mentally ill. Compulsory sterilization; removal of teeth, tonsils and internal organs to eliminate the infections that were allegedly poisoning their brains; inducing life-threatening comas with injections of insulin; subjecting them to multiple episodes of electroshock treatments day after day till they were dazed, incontinent, and unable to walk or feed themselves; damaging the frontal lobes of the brain, either with an instrument resembling a butter-knife or by using a hammer to insert an icepick through the eye socket and sever brain tissue: these were unambiguously, horrendous interventions.

This paragraph must explain my MRI and how these clinicians don't give two shits about it; correct? And what about things that cannot be photographed? Or that can and cannot go through spectral analysis to prove? What about the underhanded things clinicians do that cause permanent psychological damage that aren't so straightforward?

"The antipsychotics and antidepressants that have come to dominate psychiatric practice since the mid-1950s are a more complex matter. These drugs are no psychiatric penicillin. For some sufferers, they provide a measure of symptomatic relief - and we need to acknowledge that - but at the same time we should be clear-eyed and not exaggerate their value.

So that explains why an antidepressant that worked extremely effectively for 20 years suddenly and out of blue stop being effective causing withdrawal symptoms with a new refill? And what about the wordplay of the name of that prescription and what I'm doing now?

"While we do not have cures for diabetes or AIDS, we have managed to turn those afflictions into manageable diseases, but our pharmaceutical treatments for mental illness are nowhere near this effective. Meanwhile, the big drug companies, having made a fortune from antipsychotic drugs, and ruthlessly marketing them while concealing their drawbacks, have abandoned any attempt to develop new and improved chemical remedies. Prospects on this front, I regret to say, seem dismal at present.

Hm, see my previous comment.


"After nearly 50 years studying mental illness and following these trends, what hope can you offer us?

"Hope, in my opinion, is not yet in sight. Before we get there, we need to take a few steps.

Mhmm. *folds arms*


"First, I think psychiatry has to be more honest about its limitations and not treat biology as the primary cause and recognize the social dimension of mental illness. It needs to stop chasing magic bullets.

Yes, bullets are bad.


"Second, states and the federal government must recommit to providing the services that mental hospitals once offered: shelter, food, clothing and some semblance of social support. We need our political system to act appropriately rather than have politicians wash their hands of the situation.

MHMM... *FOLDS ARMS*


"Third, we have to rethink mental illness and accord a high priority not just to those with mental illness, but those who are incapable of providing for themselves. The depth of pain and suffering they experience is almost unimaginable, and we should be making serious efforts alleviating problems for them and the families.

Yes, SERIOUS efforts - not some bastardisation or locking of horns.


"Finally, we need to be cautious and properly skeptical when we hear of the latest claims of major breakthroughs in this field. There have been far too many false dawns. Madness refuses to bend itself to the rule of reason. It is nonetheless a riddle we must continue to strive to solve. The misery and suffering mental illness brings in its wake demand nothing less of us."

Well, it is said I am mad, but I much prefer logic, science, reason, policy, ethics, compassion, conscience, peace, and stability.