Tuesday, March 27, 2012

Beware a public backlash against psychotherapists and a return to medications

I wrote a comment about the perils of blame on the Op-Ed page at the Mad in America blog. I'm wondering if either I have got it all wrong by seeing blame in the piece where no blame was intended, or else I've rightly sensed that psychologists are publicly back to blaming family for a relative's mental illness because they are sensing a growing strength in numbers. At least one other blogger at the Mad in America site got jumped on recently for family bashing. He denied it of course, but like the Op-Ed author, he sprinkled his post with anecdotes about nasty family members of his patients. I call this kind third party relaying of a message "hear say." Perhaps it's hypocritical of me, but in my opinion, it's okay for a patient to blame a family member for his suffering (as he's 100% entitled to interpret the cause of his suffering the way he does because he knows his experience) but it's different thing for a psychotherapist to turn around and publicly make negative attributions on individuals he's probably never met outside of the therapy room. What purpose does this serve? There are ways of getting a healing message across that will not lead to charges of family bashing.

I think it's appropriate for parents and relatives to examine their role in a family member's mental illness (parents, especially), and I know how difficult it has been to get this message across in the era of no-blame antipsychotics, when parents would prefer to blame faulty biochemistry rather than venture out into more helpful ways of looking at mental illness. I do believe in personally looking in the mirror and then doing whatever it takes to changing aspects of the relationship that may have caused trauma for your relative. I do believe this and I encourage others to do the same thing because one really can help someone recover this way.

Selling the "look yourself in the mirror" message is a particular hard sell to parents because all parents feel guilty at some level about the way they have raised their children, whether there is a diagnosis of mental illness or not. Nobody likes criticism. Most people don't react well to it, unless it's done constructively. When psychiatrists or psychologists write or speak in a public forum, I believe they have a special duty to be non-inflammatory, and non-judgmental. This doesn't mean that, if they believe the family environment is an important factor in the development of mental illness, they shouldn't say so, but they should be super vigilant about how their words will be construed.

I'd like to know what you think about Albert Silver's Op-Ed piece. Is he really family bashing or have I got it wrong? I'd like to hear what you think because I believe this topic is going to become increasingly debated as psychotherapy gains ground at the expense of medications. I contributed a lengthy comment at the end of his Op-Ed in which I pointed out that there may very well be a backlash if the role of family in mental illness isn't handled constructively.


  1. In my opinion, you have it right. The intent of the author was good--and his assessments of the situation and parties may have even been accurate--however, for the reasons you state--particularly for the purpose of changing the way society and families treat people who have a diagnosis---and how we all can either contribute to behavioral difficulties and emotional distress or learn how to effectively help through examining our beliefs as to WHY these issues arise; and altering our own behavior to be supportive. Basically to learn how to validate and accept instead of invalidate and exclude. The fact is, many in our society are very invested in the notion that the symptoms develop in some sort of magical biological vacuum---and I would think that there are ways in which a message is delivered which could cause this delusion to become more entrenched. To change the paradigm, requires leaving false beliefs behind, and understanding that we all affect one another---it is not easy, to accept that one could and probably has contributed to a loved one's difficulties---but it beats the living shit out of the alternative!

  2. I don't know- is he family bashing? Maybe. But maybe he's also just acknowledging the events in that patient's past that caused the depression to show how psychotherapy would be much more desireable than medication for patients who need help coping with events that happened in the past. Could he have used another example, or worded the article differently so that something that appears to be 'family bashing' is less substantiated in the article? Sure. But the article isn't really even about how family members effect patients and whether they should be blamed. Do I agree with the assumption that the patient's wife was a manipulative woman who probably had a personality disorder? No. But I think that the article was articulated very well, and the overall message was clear- medication should not be a fist resort in patients who clearly can benefit from psychotherapy to learn how to deal with whatever the issues are that are causing the hardship.

  3. Hi Rossa

    I think you made a good point - that a reference to an unhappy marriage would have been a sufficient illustration of one cause of the patient's suffering. I am starting to think that an examination of the causes of mental illness is less important than a concentrated effort to heal them... However the damage is done to individuals, it is already done.

    However, I think that this was a careless aside in the article and that the author was really only intending to make a point about medications and health insurances. You probably did pick up on the point because you are sensitive to family issues in mental illness - and you shouldn't be, because you did your best as a parent, as all parents do as far as they are able.

    All the best, Louise

  4. I've gotten over my guilt, because IMO, all families are mentally ill to some degree or another, and it takes the person with the label to point it out to them. LOL, but of course, I'm perfectly serious.

  5. Explaining is not necessarily blaming. Understanding is much better than being drugged. Understanding might lead to relaxing and forgiving and healing.Often parents don't mean to harm their children but sometimes they do quite unwittingly.We are only human.

  6. I don't think blame is the answer.

    Part of overcoming any past event (or series of events) is to become empowered in the present moment, and gain insight into the past, but not to point blame.

    Blaming creates its own vicious cycle.
    It's not about becomiing perfect families, it's about becoming better families.

    And it requires reconcilliation (whenever possible) and forgiveness.

    A human soul may have a need to process the past, to understand it... but each of us has the ability to overcome whatever harm was done by learning that it was part of what we were SUPPOSED to go through to become who we are today.

    Once a person develops this understanding, the sky's the limit with what they can do... once they accept what happened, learn what they were suppose to learn, and then let go of the pain, release it, forgive, move on, and BECOME who they were meant to BECOME!


  7. Of course understanding is key, and of course people's emotional and other reactions should always be seen in context with their life story, i.e. not as a "symptom" but as a logic response to life, among other things to dysfunctional relationships with others. But does this only apply to the person who happens to end up in the system? Doesn't it apply to everybody else involved as well?

    IMO, the article clearly scapegoats and demonises family, just like biopsychiatry otherwise scapegoats and demonises the identified "mental patient". Personally, I would be just as careful about a therapist who engages in this kind of blame game as I would be about one who told me I was disordered and the problem. Certainly, also "negative" emotions should be allowed and acknowledged as justified. But scapegoating and demonising doesn't make for healing. It makes for getting stuck in bitterness and eternal victimhood.

  8. I sincerely hope that all the therapists who are finally being taken seriously again won't blow it by not being politic.

  9. I agree with Becky who said the author had the best of intentions and I also see where you are coming from, Rossa. As the mother of a son who had his first psychotic break in 2009, I can say the author's direct blame on the mother was disheartening. I have looked at my own role and how I can be a better mother, advocate, friend, etc. to my son. But I have also been his strongest advocate for healing and recovery without the use of drugs. So, although it was hurtful to see the mother blamed, it would never make me think mental illness is a chemical imbalance that requires drugs for a lifetime just so I could feel better about myself.


I am no longer approving comments. All I ask is that you be respectful of others and refrain from using profanity.