Jan 27Liked by Awais Aftab

Lisa thank you for this, I have followed your arc with interest from a distance and I relate very much, despite the details of our stories being very different.

In my own journey, I was privileged enough to never have to place total faith in the psychiatric paradigm in the first place, and when I ultimately experienced harm as a result of long term engagement with it (engaged for problems it was not well suited to address), I did not experience a lot of outwardly directed ire. My relationship to my drugs and diagnoses were entirely voluntary, and I never understood my “issues” as diseases for which diagnoses were names and drugs were cures. Rather, I thought of psychiatry as I THINK it is meant to be thought of: a tool to ease suffering, with clear tradeoffs. I did assume my prescribers knew more than I think they actually did, and I also assumed there was a stronger evidence base for many popular treatments, but I genuinely believed then as I do now that everyone is doing the best they can with the tools they have available to them.

My own “radicalization” happened long after I abandoned psychiatry and found my way to greater stability and personal growth in its absence.

I got involved with a state funded peer support program that worked with state hospitals and group homes. It was there that I experienced a very different use for the psychiatric paradigm than what I had experienced personally: a rigid system for organization and control that was as likely to harm as to help.

I saw up close the way the DSM and its categories were used, not just by doctors but by social workers, therapists, public health bureaucrats, insurance companies, and the courts etc. as the ONLY lens through which to make sense of the impossible task assigned to them.

I spent many hours on units with no natural light, no access to unprocessed food, and no privacy where people languish for years at ENORMOUS cost to the taxpayer, hundreds of thousands of dollars per patient annually.

I saw the outrageously long med histories, and tried my best to engage in conversation with people taking upwards of 15-20 powerful drugs a day, at enormous doses, for years. I met people who encountered psychiatry as children and never had the chance to develop into social beings due to constantly being ripped off and put back on drugs, the withdrawals being mistaken time and time again for symptoms of ever more diagnosable disorders. Perhaps most wicked, I learned how insurance companies force good, thoughtful, cautious practitioners to strip their prognoses of nuance and context in order to get people any care at all, because if you don’t have a code you don’t have a problem.

There were success stories as well, and many many good people working at all levels. But the takeaway for me is that regardless of academic arguments over the objectivity or reliability of the psychiatric paradigm, there is something happening here that the public would not approve of if it knew it was happening.

That radicalization was almost immediately tempered by the cold hard facts: what good would public outrage do if there’s no realistic alternative? I hardly think you can just throw open the windows and doors, put everyone on keto diets and manage chronic psychosis AT SCALE with EMDR and chair yoga.

The harms are real, and the problems are significant, and I completely understand the emotional charge that leads people to want to just burn it all down. I also have seen many people make use of anti psychiatry outrage as a means to move beyond the helplessness and grief of acute psychiatric drug harm/withdrawal into righteous anger, which I think can have enormous therapeutic value. But like you, I see people get stuck in that place, raging against the machine and unwilling or unable to step back and approach the issue with any pragmatism.

I also see academic psychiatrists defending the principles of the paradigm, responding to anti and critical psych critiques with something like, “Hey Now! The DSM is a pragmatic tool to assist in guiding treatment, nobody is claiming it’s a directory of actual biopathology!”

To them, i want to say “great, I’m glad we agree, now please make sure to tell that to:

Ins. Companies

Courts, Judges and Juries


Social Workers

Guidance Counselors

Primary Care docs


I guess my point with all this is that I REALLY appreciate you sharing your story, and I agree with your sentiment that getting stuck in anger, or overidentifying with one’s own iatrogenic injury can be counterproductive in all of this, both on an individual level and on a systems change level. My agreement there is pretty emphatic. IMHO Unless people are willing to actively dismantle the false “pro/anti” binary and get specific and pragmatic with their critiques and defenses, the perverse incentives and bad practices will only get worse.

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Well said

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Well said, all of it!

And yeah, that last part is so true - sometimes, clinicians and researchers who are smart and nuanced people and only hang out with other smart and nuanced people make these blanket claims about how NO ONE thinks the DSM is the holy Bible and mental illness is just like diabetes and you gotta take all the meds just like diabetics must take their insuline blablabla this is JUST a strawman, NO ONE thinks or says this -

eh, no. Wish that were the case, but no.

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Jan 27Liked by Awais Aftab

Thanks for telling your story. Yeah, it's hard to find a balance. I've encountered plenty of the angry antipsychiatrists you talk about, but also their antithesis: psychiatric patients who believe that in order to get better, you must never question anything your doctor says, the doctor is always right, and the system is perfect, always trust the system (considering how much doctors can disagree with each other, it's straight-out contradictory to suggest that all doctors are always right!).

Navigating the mental health care system really requires finding a balance. One must realize that there are many problems and shitty doctors but ALSO proper research and evidence-based treatments and wonderful docs who do their best.

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