Huw Green on the clinician’s illusion

About the author

I am a PhD student and trainee clinical psychologist based in New York. My research is on the mechanisms of Auditory Hallucinations and the social epidemiology of psychosis. In addition to this I am also interested in the philosophical and conceptual problems around diagnosis and the history of Schizophrenia.


The Clinician’s Illusion: A Powerful Source of Bias Three Decades On.

Talking therapies and magical voluntarism


Taking down the talking cure

Review of The Therapy Industry: the Irresistible Rise of the Talking Cure, and Why it Doesn’t Work
By Paul Moloney, Pluto Press, 2013

David Smail on magical voluntarism: 

Distressed people are supposed, 
via a short but perhaps intense period 
of interaction with a practitioner, 
to transform themselves 
into people no longer feeling distress. 

I wrote about pscientific fundamentalism in my previous post, and in this one I recommend two books by David Smail that I’m reading at the moment:

Amazon link:

If you prefer to read things online, here’s a collection of Google links on ….
Smail magical voluntarism

Quoting from: 
Social Power and Psychological Distress 
A talk given by David Smail in Nottingham, 14/10/02

Over the years, the psychotherapies have attempted to deal with this difficulty in various ways, often by trying to represent the movement from diagnosis to cure as somehow automatic. The psychoanalyst’s interpretations, etc., will lead through the process of ‘insight’ to an adjustment of the internal, unconscious processes that were causing the trouble. At the other extreme, it will be incumbent on the client of cognitive therapy actively to undertake the learning regimen prescribed by the therapist such that the offending ‘cognitions’ may be ‘restructured’. It’s usually not long before the inadequacy of these ideas (principally, the observation that they don’t work) leads to the conviction that nothing much can be achieved without the patient’s willed co-operation in the process of cure. This boils down in the end to the frank acknowledgement that whether or not someone gets better is a matter of their own ‘responsibility’, and indeed the notion of ‘responsibilty’ became a central pivot of humanistic approaches. 

Now I think we’re operating with a very strange, essentially pre-scientific model here, one in fact that has more in common with seventeenth century magic and astrology than it does with modern scientific medicine (not that that’s always everything it’s cracked up to be). Indeed, I think one could call the philosophy that underlies most present-day psychotherapy and counselling one of ‘magical voluntarism’. Distressed people, that is to say, are supposed, via a short but perhaps intense period of interaction with a practitioner, to transform themselves into people no longer feeling distress. 

Now a lot of people, I’m sure—and especially counsellors and therapists—will see nothing much the matter with this, but in my view it does begin to suggest that there is something really rather important that we have been leaving out of the picture. We seem to have been assuming, that is to say, that ‘there is no such thing as society’—or that if there is, it has no particularly significant role in determining how we feel. 

With a few honourable exceptions, the idea that people suffer psychologically because of the way the world is has not greatly preoccupied mainstream psychological and psychiatric theorists. Even though those who have taken society seriously may have enjoyed a voguish success in their time (I’m thinking of the obvious names like Alfred Adler, Erich Fromm, Karen Horney, Harry S. Sullivan, R.D. Laing), their fate seems to be to end up in the margins, where also are to be found minority disciplines like social psychiatry and community psychology. 

Link to a rather critical review that made me very interested in the book: 

Why Therapy Doesn’t Work and What We Should Do About It and The Nature of Unhappiness 
by David Smail

Reviewed by Roy Sugarman PhD, Senior Clinical Neuropsychologist, Glenside Campus/RAH, Clinical Lecturer, Dept of Psychiatry, Adelaide University

And a review by Andy Fugard,  lecturer at University College London: 

Book review: Power, interest and psychology by David Smail (2005)

Therapy, Smail argues, tries to boost the perception of clients’ power to change, when in reality it is actual power that clients often need: power over material resources, money, employment, education; personal resources such as confidence and intellect; home and family life, a love life, and an active social life (Hagan & Smail, 1997). These are areas which often cannot be influenced by talk in the clinic. So why has individual therapy grown so popular? Smail argues – and emphasises that it’s nothing to be ashamed of – that therapists rely on income to put food on the table and pay the rent, just like their clients. He illustrates with the example of Sigmund Freud (p. 3) who wrote that “My mood also depends very strongly on my earnings… I have come to know the helplessness of poverty and continually fear it”. Freud, he argues, changed his theories so as not to offend those who paid the bills, e.g., clients’ parents. Smail argues that there is a great mysticism around therapy (p. 8): “rituals of therapeutic cure… bear a strong resemblance to the spells and incantations of sorcerers”, with practitioners rarely explaining to clients how their techniques (supposedly?) work. Together these interests help sustain psychotherapy.

Thanks to Andy Fugard for suggested Smail’s books on Twitter. I have been using the term “societal harm” instead of “mental illness” for almost 25 years, and find much in them that fits this frame of thinking.

Linking to a post about a discussion on societal harm:

Smail is discussing the visible external forces of power that create societal harm; I haven’t found any awareness of society’s invisible war on the vulnerable:


Edited Dec 1st 

I found this in my feed today, via @agteien:


And it  fits well in with this:

Antidepressants are not ‘happy pills’

This blog post by psychiatric trainee Alex Langford moved me to look up the word  “fundamentalism”: 

“a movement or attitude stressing strict and literal adherence to a set of basic principles” 

Then I googled “psychiatry fundamentalism” – and found a book by Sami Timimi: 

It was published in 2002, and there are no reviews on or

A  screenshot describing what I call“pscientific fundamentalism”: 

I also found some reviews that seem to confirm the fundamentalist mindset of mainstream psychiatry:

A talk by Timimi

Introducing Oglaf

Some tweets about a muse reminded me of this:

your muse has been stealing ideas
And this:

is there a 'least dramatic fight scene' award?

Here is some information about the creators:

“This comic started as an attempt to make pornography. It degenerated into sex comedy pretty much immediately. Even so, there are some things depicted that are best kept away from children and work. Please click on the button below to certify you’re over 18. Of course, if you areunder 18, you can’t legally certify anything. So if you’re a minor, please get a parent to click the button which says you aren’t. Thank you. (Taking moral advice from cartoon characters is probably a bad idea.)”
— opening disclaimer

Oglaf is an often seriously NSFW webcomic by Trudy Cooper and Doug Bayne. Most of the episodes (called “stories”) are single non-sequential pages, though some stretch out longer; the very first one was eight pages long. The comic started out as a gag-a-week work, but slowly started including longer Story Arcs, most of the time focusing on Ivan and his never-ending torment at the hands of Mistress and Sandoval, the Ambassador of Xoan. These arcs appear to be (very) slowly coming together into a single overarching plot.

There is even an Oglaf Wiki:

Two more stories that are SFW:

Labyrinth 2

Sam Kriss: "The DSM-5: A Dystopian Novel"

The original post will be rewritten. In the meantime, here’s another dystopia: 

Sections like those on the personality disorders offer a terrifying glimpse of a futuristic system of repression, one in which deviance isn’t furiously stamped out like it is in Orwell’s unsubtle Oceania, but pathologized instead. Here there’s no need for any rats, and the diagnostician can honestly believe she’s doing the right thing; it’s all in the name of restoring the sick to health. DSM-5 describes a nightmare society in which human beings are individuated, sick, and alone.  

I have been reading the mental illness sections of the ICD-10, and there I also find “a nightmare society in which human beings are individuated, sick, and alone”. 


There is some recycled material from earlier blog posts.
I will be adding relevant links as I find them. 

Links to:

Who are “people”?

DR LANGFORD: You see, people think that physical health is perfectly scientific, that patients fall into neat, valid little boxes, that there are tests that give yes/no answers for every condition. Anyone who tells you these things has not worked in general medicine.

Sure, some patients fall easily into boxes; big heart attacks, massive strokes, overwhelming chest infections…but most patients have a collection of small problems, all in the ill/not ill grey area, which add up. This is why when our elderly relatives are admitted to hospital, the doctors tell us things like “maybe a small stroke” or “a small heart attack but we’ll treat him for an infection just in case”. It’s nonsense to say that big hearts attacks aren’t real because lots of people have small ones…we just have to be wary that illness isn’t a precise concept anywhere in medicine – psychiatry is not alone in this.

Reality check:

Do people who criticize psychiatry give a frak about correlation co-efficients?

Do people who criticize psychiatry expect psychiatry to be perfect or scientific?

Do people who criticize psychiatry want psychiatry to take responsibility for the deaths it has caused, the lives it has mangled?

Are people who criticize psychiatry angry about (well-meant, by all means) humiliation, discrimination, dehumanisation, abuses of psychiatric power, and psychiatry’s narrow-minded blindness to lived lives, experience, dignity, intelligence, civil rights and autonomy?

Are people who criticize psychiatry angry about psychiatry’s penchant for jumping to conclusions and sticking to first impressions?

I can only speak for myself, and I am angry. Calmly angry, but angry at what correct and legal psychiatric labeling did to me, and what it has done and is doing to others: 

From Compliance to Activism: A Mother’s Journey

During his first involuntary admission to Western State Hospital at age 18, Siddharta was asked what he thought had caused his psychological troubles. According to physician notes, Siddharta described being falsely charged and convicted for stealing a girl’s coat at age twelve. He described the instability of growing up amidst the turmoil between his parents. And he described being raped by a male drug dealer – an incident that Cindi had never heard about. It happened shortly before his crisis at age 17.

However, apart from these initial notations, Cindi says she found no other indications in Siddharta’s medical records that his care providers ever developed therapeutic strategies for her son’s emotional issues. Instead, Siddharta’s primary problem was identified simply as “schizophrenia,” and the prescribed treatment was psychiatric drugs.

Cindi says his providers apparently did not report this sexual assault of a minor to police, as was required by state law. Is it possible that the psychiatrist thought that the rape was merely a hallucination produced by Siddharta’s schizophrenia? “Well, everything else he said made sense,” replies Cindi. “If you really wanted to look, to see what would cause all this, [the reasons] were there. But if you wanted to look and see a mentally ill black boy, that’s what you saw.”

Requoting you, Dr Langford: ” … we don’t have to start from square one with everyone that comes through the door. So mental illness is a useful concept.

“Mental illness” was not a useful concept for Siddharta. What could his life have been like if psychiatrists had started from square one and found him before they stuck a schizophrenia label on him?

The power of psychiatry …

Please correct me if I am unfair: Psychiatry has the power to override basic civil rights, humiliate, incarcerate, intimidate, label and dehumanise, pathologize dissent, autonomy and responsibility, influence the legal system and influence the way GPs, medical specialists, other mental helpers, work and welfare and social services behave towards people who need help.

And more than any other medical speciality, psychiatry has the power to ignore information about harm it does, and it has the power to blame its mistakes on the “illness” of its patients.

In that sense, the concept of psychiatric illness is very useful to psychiatrists. But is it real?

DR LANGFORD: Every speciality changes its classification of illnesses every few years, as we learn more about illnesses, but only psychiatry gets abuse for doing so. How high your blood pressure has to be to be high changes every 5 minutes, we used to have bronchitis and emphysema but now we have COPD, the stages and groups of cancers changes every few years. Making categories more accurate is important and I look forward to seeing them improve with time.

Has psychiatry gotten abuse for changing its classification of illnesses? I haven’t noticed that, but I have noticed that the DSM-5 is being criticized for repression and narrow-minded silliness. 

Linking to someone who has read it:

Diagnosis and the DSM: A Critical Review by Stijn Vanheule

The second chapter focuses on how the DSM-5 takes context into account and discusses the kind of entity the DSM considers mental disorders to be. The main argument I make is that in the DSM the context of the individual (i.e., the life history, social circumstances, and cultural background) is thought to play only a minor moderating role in relation to symptom formation and expression. Moreover, as the manual follows a sign-based logic it coheres with the assumption that biological irregularities lie at the basis of mental distress. In this way the DSM cultivates a rather naïve essentialistic view of mental disorders, which is certainly not supported by relevant evidence. 

The DSM-5: A Dystopian Novel by Sam Kriss

Sections like those on the personality disorders offer a terrifying glimpse of a futuristic system of repression, one in which deviance isn’t furiously stamped out like it is in Orwell’s unsubtle Oceania, but pathologized instead. Here there’s no need for any rats, and the diagnostician can honestly believe she’s doing the right thing; it’s all in the name of restoring the sick to health. DSM-5 describes a nightmare society in which human beings are individuated, sick, and alone.  

I have been reading the mental illness sections of the ICD-10, and there I also find “a nightmare society in which human beings are individuated, sick, and alone”. 

And in social media I find professional denial of oppression and dehumanisation:

Which I consider quite natural, as I do not think that “oppress and dehumanise” is in the job description of people in helping professions. Therefore I choose to assume that they have the very best of intentions, and I ask: 

What does psychiatry create?

  • It creates filters that block out society’s war on the vulnerable … and this filtering creates suppression and oppression of people in pain. 
  • It creates humiliation and dehumanisation of the people it is helping. 
  • It creates CATCH-22.
  • And it creates defenses against responsibility for its actions. 

… and the desperation of individual psychiatrists

DR LANGFORD: Let’s be clear on another thing – psychiatry is not “growing out of control”, “medicalising normal emotions” – you only need to read the headlines about the shameful ways our services are being cut to see that.

Being told that psychiatry has a lot of power might seem meaningless to a frontline psychiatrist like you, who is trying to do a good job in a sector that is eroded by budget cuts. 

And I have some questions:

Are budgets being cut because politicians believe that psychiatry is “growing out of control” and “medicalising normal emotions”?

I have been searching for the context of “growing out of control” and couldn’t find anything. Who is accusing psychiatry of this?

What do psychiatrists do to reality check and double-check if post-traumatic stress, anorexia and other eating problems, obsessive-compulsive behaviour, deficits of attention, paranoia, symptoms of border violations, depression, hallucinations and weirdness etc are natural reactions before they medicalise?


Who are “some people”?

Respectfully giving you something else that you have done: You created a tangled mess in your next sentence. 

Mental health is being suffocated, and our patients with it, because it is seen as less deserving because some people are still willing to get up on stage and tell you that they don’t believe mental illness even exists.

Let’s see …

Since you mention “get up on stage”: are you accusing your opponents in the debate at the Dana Centre of suffocating mental health and your patients?

Are psychiatric budgets being cut because other mental help professions disagree with the diagnostic frame of psychiatric illness?

Do you have evidence that your opponents at the Dana Centre insist that dementia or autism, which you call mental illnesses, are “mental problems”? 

Are people like me, who prefer to deal with our mental problems without psychiatric help, suffocating mental health and psychiatric patients?

Do you have evidence that mental health care is seen as less deserving because psychiatry is being criticized? 

Seems to me that mental health care is seen as less deserving because politicians couldn’t care less about “the mentally ill”. Maybe they, like the general public, have been influenced by psychiatry’s well-meant and misguided othering


There is some recycled material from earlier blog posts.
I will be adding relevant links as I find them. 

Links to:

DR LANGFORD: By recognising that certain symptoms often occur together, like flashbacks, being on edge and feeling numb and by giving this syndrome a namein this instance PTSD, we can do research into causes, and treatments that might work.

There has been much research over the years. Do you have evidence that research has found treatments that work?

Why suicide rate among veterans may be more than 22 a day By Moni Basu, CNN

Would you tell a person who has multiple fractures in both legs after a car accident that they have an illness?  A disorder? Maybe a Compound Bipedal Ambulatory DisorderIn my frame, the concept of “post-traumatic stress disorder” is just as ridiculous. 

Post-traumatic stress is a natural reaction to traumatic stress. When experts label it an illness, a disorder, they are humiliating wounded people and filtering out helpful help. 

I couldn’t believe my ears when a famous Norwegian psychiatrist said on TV many years ago that refugees from war zones needed to mingle with normal people and learn that life is peaceful and good. That attitude is a huge part of the problem: “Normal” people invade the personal stories of wounded people with a collective story of “you just need to be more like us”, which creates “the problem is that you are not like us”. 




Post-traumatic stress reactions

Sending anguished veterans off to talk to therapists conveys the message that the rest of us don’t want to listen—or that we don’t feel qualified to listen. As a result, the truth about war is kept under wraps. Most of us remain ignorant about what war is really like—and continue to allow our governments to go to war without much protest. Caplan proposes an alternative: that we welcome veterans back into our communities and listen to their stories, one-on-one. (She provides guidelines for conducting these conversations.) This would begin a long overdue national discussion about the realities of war, and it would start the healing process for our returning veterans.

And this applies just as much to post-traumatic stress from other horrors. You don’t need a psych degree to listen, you need to respect the vulnerability of the person who is talking. And you can do that by connecting to your own vulnerability. 

DR LANGFORD: Sometimes we even find a cure. We learn from these patterns we see in people – we don’t have to start from square one with everyone that comes through the door. So mental illness is a useful concept.

Please link to evidence that psychiatry has found cures for mental illnesses.

And please link to evidence that the patterns psychiatrists see in people are scientific and evidence-based. 

Where you write “patterns”, I read “knee-jerk reactions”. So I ask again: What do psychiatrists do about the homunculi who are jumping up and down in their heads? Everyone has one, so psychiatrists are not exempt.  

The patients Jake is telling us about are desperate for psychiatrists to start from square one, as Dr Nguyen describes it in “The Ethics of Trauma”:  

 …“remaining in empathic unsettlement”: to stay unsettled in order to look at, not past or beyond, the subject. To stay in the not knowing and trying to know with the subject …

So … for whom is the concept of psychiatric illness useful? 

It is useful for the patients it fits … keeping in mind all the narratives of people who fit until the side-effects of drugs become a problem. I’ll be following the Council for evidence-based psychiatry with great interest. 

The concept of mental illness provides heuristics – “patterns we see in people” – that lead to quick and confident System 1 conclusions, so it can be useful to helpers who do not have a mentalising approach.

And it is useful for parents and other people with power who reject responsibility for actions that harm the vulnerable. 

And psychiatric diagnoses are useful frames of reference for institutions, researchers, health services, social services. 

But what about all the people who do not fit into this concept of psychiatric  illness?

Scientific contrarians like Semmelweis  were my childhood heroes, and it does me good to know that such people still exist. 

DR LANGFORD: But is it a valid one – are mental illnesses real? Of course they are. Some mental illness or disorders are quite plainly real.

Dementia, addiction, severe autism and learning difficulties are all expressed through the mind, and therefore listed in those evil “psychiatric bibles” – but no one would argue that they didn’t exist.

Are you insisting that mental problems do not exist because “Some mental illnesses or disorders are quite plainly real”. 

In that category of “expressed through the mind”you have placed dementia, addiction, autism and learning difficulties. I agree that all of them are expressed through the mind, but I cannot agree that all of them are “mental illnesses”.

Dementia is a real illness, caused by changes in the brain that can be induced by psychiatric drugs.

And autism is a physical condition, illuminatingly described in The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism.

In my context, addiction is a natural defence against the pain and memories of societal harm, a mental problem and not a psychiatric illness.

And while some learning difficulties can have physical causes, learning difficulties can also be caused by invisible wounds: Children Who Are Spanked Have Lower IQs, New Research Finds





Post-traumatic stress reactions

Learning difficulties

Learning difficulties

DR LANGFORD: But as soon as something is found to have a solid cause in the brain, it tends to get called “neurology”, so the heat can be kept focussed on psychiatry, on disorders for which a biological focus is less clear cut.

Why don’t psychiatrists use their medical training to look at how societal harm can cause both physical illness and mental problems? 

What would your next argument look like from this viewpoint?

And who are “some”?

DR LANGFORD:Some say, well, you’ve had years to find a simple cause or test for these disorders, things like depression, and you haven’t done it. So depression can’t be a real illness! But medicine doesn’t work like that. We don’t suddenly decide that the symptoms don’t add up to an illness just because we haven’t found a cause or a test yet – because the symptoms are there.

Maybe psychiatry hasn’t found a cause or test for depression because it has its head stuck in the brain? What might it find if it took depression out of the intuitive box of psychiatric illness and instead looked for individual loss and trauma and large and small border violations? 

We don’t even have a good idea what causes migraines yet, we certainly don’t have a test, but no one will be telling people with headaches that sorry, no clear cause yet and no test, so no illness. So we won’t stop calling things like OCD and bipolar disorder illnesses. Our patients deserve better than that.

In my frame, your patients deserve to be asked, by a mentalising helper who is in square one,  “in the not knowing and trying to know with the subject”: 

“What do you think your problem is?”

“What has happened in your life?”

“What are your days like?”

“What do you need?”

And I cannot agree that obsessive-compulsive reactions and bipolar belong in the same category.

In my frame of invisible wounds, obsessive-compulsive reactions belong with addictions in the category of “natural defense reactions to the pain of societal harm”.

Bipolar? Some people are helped by treatment of bipolar as a medical illness. 

Bipolar can be a side-effect of antidepressants. 

And I know people who lost their symptoms when they began to sceptically investigate their lives: The manic phase had been an intense attempt to shut out intrusive memories and emotions, and the depressive phase was exhaustion.





Post-traumatic stress reactions

Obsessive-compulsive reactions


Learning difficulties

Learning difficulties

Who are ” a lot of people”?

DR LANGFORD: A lot of people think that no two psychiatrists will agree on a diagnosis, that there is no reliability, but the reality in very different. Here are some correlation co-efficients – the closer to 1.0 the number is, the more psychiatrists agree on the diagnosis. Anywhere near 0.7 is pretty damn good. Mostly ok.

This brings on a smile. The specific examples you have chosen can probably be diagnosed with pretty good correlation co-efficients by an informed layperson. 

I have many links about confusing multiple diagnoses, but I’ll let them lie.

Commenting in your table: 

Autistic Spectrum Disorder

I agree that autism stems from the brain. And here is information about harmful psychiatric medication of children with autism:


Not a disorder or illness. Post-traumatic stress is “a normal reaction to abnormal events”, according to this website :     

There I found an article on Emotional and Psychological Trauma

And I quote:

Childhood trauma increases the risk of future trauma

Experiencing trauma in childhood can have a severe and long-lasting effect. Children who have been traumatized see the world as a frightening and dangerous place. When childhood trauma is not resolved, this fundamental sense of fear and helplessness carries over into adulthood, setting the stage for further trauma.

Childhood trauma results from anything that disrupts a child’s sense of safety and security, including:

  • An unstable or unsafe environment
  • Separation from a parent
  • Serious illness
  • Intrusive medical procedures

 Symptoms of emotional and psychological trauma: Following a traumatic event, or repeated trauma, people react in different ways, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond to trauma, so don’t judge your own reactions or those of other people. Your responses are NORMAL reactions to ABNORMAL events.

In an editorial to “Today’s children are tomorrow’s parents”Dag Nordanger writes:

This special issue of “Today’s children are tomorrow’s parents” is dedicated to the topic of “Childen and trauma”. Most likely, if such an issue was produced 15 years ago, its focus would have been quite different. Probably, articles would have focused more on dramatic events visible to the public, such as accidents, disasters and sudden loss. Moreover, it would have been inappropriate at the time not to focus particularly on the Post traumatic stress disorder diagnosis – its origins, symptoms, and its treatment. Since then we have learned that although these are severe sources of stress for a child, the most devastating traumatic events happen in rooms hidden to the public. We have learned that those experiences which threaten the health and development of a child the most are the complex traumas – the persistent traumas which undermine the child’s secure base and the relationship to primary caregivers. Examples of such traumas are child maltreatment or abuse, or getting the platform of one’s life torn apart because of war and flight. We have also learned that when the traumas are complex, the health consequences are complex as well, and cannot be limited to a certain existing diagnostic category such as PTSD.

What is psychiatry doing to incorporate research on complex traumas into its cognitive frame?


Bipolar Disorder

People have been helped within your frame, I give you that. Bipolar seems to be the poster child of psychiatry.

And Peter Gøtzsche from the Nordic Cochrane Centre writes: 

In 1987, just before the newer antidepressants (SSRIs or happy pills) came on the market, very few children in the United States were mentally disabled. Twenty years later it was over 500,000, which represents a 35-fold increase. The number of disabled mentally ill has exploded in all Western countries. One of the worst consequences is that the treatment with ADHD medications and happy pills has created an entirely new disease in about 10% of those treated – namely bipolar disorder – which we previously called manic depressive illness.

Leading psychiatrist have claimed that it is “very rare” that patients on antidepressants become bipolar. That’s not true. The number of children with bipolar increased 35-fold in the United States, which is a serious development, as we use antipsychotic drugs for this disorder. Antipsychotic drugs are very dangerous and one of the main reasons why patients with schizophrenia live 20 years shorter than others. I have estimated in my book, ‘Deadly Medicine and Organized Crime’, that just one of the many preparations, Zyprexa (olanzapine), has killed 200,000 patients worldwide. – See more at:

Borderline Personality Disorder

I decided a long time ago to flaunt my borderline diagnosis as a banner of autonomy. That liberated me from the shame and humiliation that is a harmful side-effect of borderlining. 

Rebecca J Lester describes this in  Lessons from the borderline: Anthropology, psychiatry, and the risks of being human:

Clinicians generally detest working with borderline patients.These clients can present as unpredictable, needy, hostile, overly dramatic, and emotionally draining. As McGlashan (1993: 241) observes: ‘Officially, ‘borderline’ is a diagnostic label. Unofficially, in clinical parlance, it is synonymous with ‘anathema.’’ Gabbard  (1997: 26) elaborates: ‘A significant number of professionals within the industry regard borderline patients with contempt.’ And as one psychiatrist told anthropologist Tanya Lurhmann (2000: 113), you look for the ‘meat grinder’ sensation: if you are talking to a patient and it feels like your internal organs are being turned into hamburger meat, she’s probably borderline.

Link to: People with a borderline personality disorder diagnosis describe discriminatory experiences

The experiences described by some participants regarding making complaints provide food for thought; the idea that making complaints is typical behaviour for someone with a BPD diagnosis seems to be a powerfully silencing one, positioning the client as someone whose complaints are trivial and/or pathological. The idea of BPD diagnosed clients as prone to making complaints probably also has ties to this client group being seen as difficult and angry, and being responsible for ‘splitting’ staff (Gallop 1985). 

In my frame, the symptoms that get labelled Borderline Personality Disorder are symptoms of societal harm, loss, trauma and border violations. The meat grinder sensation is discomfort at getting a glimpse into an invisible war zone that the professional does not want to know about, and the diagnosis of “Borderline Personality Disorder” is generated by a professional Somebody Else’s Problem field and upheld by little homunculi that are jumping up and down in professionals’ heads.

In a strange double bind, psychiatry is clear about there being no need to be ashamed of having been sexually used, hit or gaslighted – and then treats the symptoms of having been used, hit or gaslighted as shameful and contemptible personality defects. 

Borderline personality disorder: Abandon the label, find the Person 
by Steven Coles

Linking to “Is Anakin Skywalker suffering from borderline personality disorder?” This might seem like a reasonable question to a psychiatrist:  

Anakin Skywalker, one of the main characters in the “Star Wars” films, meets the criteria for borderline personality disorder (BPD). This finding is interesting for it may partly explain the commercial success of these movies among adolescents and be useful in educating the general public and medical students about BPD symptoms.

We are three generations of Star Wars fans in my family, and my children and grandchildren have often started discussions about this universe. Looking at how the character’s lives shape their actions and their options has led to useful explorations of free will, ethics, responsibility and values in the world we live in, far, far away from the fixed and pathologizing mental illness frame of psychiatry.  

A huge problem with the limited psychiatric illness model is that it gives up on people with “personality disorders”. I’ll be following this program with interest: 

 “Some psychopaths can be treated”
David Bernstein, Sacha Ruland


Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren’t there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. For women, they start in the mid-20s to early 30s. 

Other symptoms include:

unusual thoughts or perceptions

disorders of movement

difficulty speaking and expressing emotion

problems with attention, memory and organization

no one is sure what causes schizophrenia, but your genetic makeup and brain chemistry probably play a role. Medicines can relieve many of the symptoms, but it can take several tries before you find the right drug. You can reduce relapses by staying on your medicine for as long as your doctor recommends. With treatment, many people improve enough to lead satisfying lives.

Do you agree with this description from the ICD-10? 

What is your opinion on this description from BrainBlogger:
Is Schizophrenia Really a Brain Disease?

In spite of over a hundred years of research and many billions of dollars spent, we still have no clear evidence that schizophrenia and other related psychotic disorders are the result of a diseased brain. Considering the famous PET scan and MRI scan images of “schizophrenic” brains and the regular press releases of the latest discoveries of one particular abnormal brain feature or another, this statement is likely to come as a surprise to some, and disregarded as absurdity by others. And yet, anyone who takes a close look at the actual research will simply not be able to honestly say otherwise. And not only does the brain disease hypothesis remain unsubstantiated, it has been directly countered by very well established findings within the recovery research, it has demonstrated itself to be particularly harmful to those so diagnosed (often leading to a self-fulfilling prophecy), and is highly profitable to the pharmaceutical and psychiatric industries (which likely plays a major role in why it has remained so deeply entrenched in society for so many years, in spite of our inability to validate it).

And what is your opinion on the varieties of non-medical treatment of schizophrenia, as described in the following links?

The society recommends a lot of books. I like this one: 

Models of Madness 2nd Edition 

John Read (Editor), Jacqui Dillon (Editor)

There is much sceptical interrogation of “schizophrenia” here. 

A review by Lois Achimovich: 
Review of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia

“This is mandatory reading for all psychiatrists. Read et al. have issued a serious challenge to psychiatry. Are we totally on the wrong track with both understanding and treating schizophrenia? Are we doing more to create mental disorder than to prevent it? Since we have shuffled off responsibility for almost everything except mental illness, this challenge to the medical model suggests that we may have sawn off the last branch on which we had any purchase.” – Carolyn Quadrio, Australian and New Zealand Journal of Psychiatry

This book deals with many different non-medical approaches to psychosis and “schizophrenia”: Alternatives Beyond Psychiatry  by Peter Stastny (Editor) , Peter Lehmann (Editor)


And now my table looks like this:




Post-traumatic stress reactions

Obsessive-compulsive reactions





Learning difficulties

Learning difficulties

Surely physical health problems all score 1 though? I’m afraid not. Here are the scores for a few physical conditions.

Why do you use the word “problems” about physical illness when you are arguing that mental problems do not exist?

Atherosclerotic stroke
Lung cancer under a microscope
Osteoarthritis on X ray
Reflux using endoscopy
Heart attack using blood test and ECG
Smaller stroke

I am going to compare psychiatry with translation again: It would be stupid to say that “Journalists also make mistakes!” when explaining why translation is useful. Yet psychiatrists seem to think that “other specialties aren’t perfect either” is a valid argument.

Michael A. Susko: Caseness and Narrative: Contrasting Approaches to People Who are Psychiatrically Labelled

This paper should be required reading for everyone who works in the helping professions:
With naming comes a transfer of ownership of the person’s mind and body to the professional. 
What Susko call “caseness” is my reason for rejecting the concept of psychiatric illness. And substituting “brain disease” with “mental illness” does not remove that.


There is some recycled material from earlier blog posts.
I will be adding relevant links as I find them. 
Edited may 30th

Links to:

Definition of “Stigma” from Oxford Dictionaries:

  • 1A mark of disgrace associated with a particular circumstance, quality, or person:the stigma of mental disorderto be a non-reader carries a social stigma

The meaning has supposedly shifted : According to Merriam-Webster it is ...

: a set of negative and often unfair beliefs that a society or group of people have about something

But “mark of disgrace” seems to be a better fit for society’s attitude to people with mental problems. 

So why not call it discrimination? : a set of negative and often unfair beliefs that a society or group of people have about something” 

Or prejudice? : an unfair feeling of dislike for a person or group because of race, sex, religion, etc.”

Is the  word “stigma” used in other contexts? I haven’t seen “the stigma of dark skin colour”, for example. And “the stigma of mental illness” is just as discriminatory and prejudicial. More about this further down.

DR LANGFORD: Using the word illness, not just “problems”, ensures that society treats people with mental illnesses with the respect they deserve; not just lazy, peculiar, and malingering.

Could you please link to evidence that using the words “mental illness” ensures that society treats people with respect? 

That looks like a Nirvana Fallacy to me. Reality check: 

1) The psychiatric idea that the word “illness” will remove stigma demonstrates a frightening ignorance of basic human nature. Susko writes: 

 … for mainstream culture, disease, illness, chemical imbalance, and genetic defect have only a pejorative meaning. Where productivity and “survival of the fittest” are heavily valued, disabled people or those who drop out of the work force are stigmatised . The concept of a “diseased mind” carries connotations that are doubly negative. Not only does it evoke disability, but it arouses fear – and implies that a person is not responsible for his or her mind, or is difficult, unpredictable, and potentially violent. The net effect is a marked lowering of the individual’s social status.

2) The side-effects of many psychiatric drugs are not only horrible for the persons taking them, but often visually stigmatizing … it is easy to see that “they have a diagnosis”.

JAKE: 3.00 A lot of people don’t want to take anti-psychotics (…) I’ve seen people develop diabetes very young, I’ve seen people very bloated, I’ve seen stiffness, a lot of people complain about apathy, difficult in concentrating, depression, these kind of symptoms. You see people with Parkinson’s disease kind of symptoms, shaking, tongue is flicking in and out, and that’s from the antipsychotics and it’s irreversible. So people have quite good reasons to object to these drugs. (…) once the person objects to the drugs, they will be forced into taking the drugs. And there’s not really much negotiation.

3) There are many psychiatric drugs amongst the Top Ten Legal Drugs Linked to Violenceso society links “mental illness” to violence. 

4) The word “disorder” is in itself stigmatizing as a description of mental symptoms. When someone has post-traumatic stress disorder, wrongness is automatically linked to the person, and not to the events that caused stress.

I just can’t wrap my mind around this: Using the word “disorder” to tell people that they have a mental illness that is nothing to be ashamed of, it’s just like diabetes or any other physical illness.
How can any amount of anti-stigma campaigns neutralize the wrongness that this word conveys?

: a confused or messy state : a lack of order or organization

: a state or situation in which there is a lot of noise, crime, violent behavior, etc.

medical : a physical or mental condition that is not normal or healthy

Full Definition of DISORDER

:  lack of order

:  breach of the peace or public order

:  an abnormal physical or mental condition  

Examples of DISORDER

The mayor is concerned that a rally could create public disorder.

… problems of crime and social disorder

Millions of people suffer from some form of personality disorder.

Related to DISORDER 


chance-medley, confusion, disarrangement, disarray, dishevelment, chaos, disorderedness, disorderliness, disorganization, free-for-all, havoc, heck, hell, jumble, mare’s nest, mess, messiness, misorder, muddle, muss, shambles, snake pit, tumble, welter


order, orderliness

Related Words

anarchy, lawlessness, misrule, riot; knot, snarl, tangle; labyrinth, maze, web; maelstrom, storm; bollix, clutter, litter, mishmash, shuffle; hodgepodge, medley, miscellany, morass, motley

Near Antonyms

method, pattern, plan, system 

5) Some psychiatric diagnoses, like “Narcissistic personality disorder”, are extremely stigmatizing. From the 2014 ICD-10:

“A disorder characterized by an enduring pattern of grandiose beliefs and arrogant behavior together with an overwhelming need for admiration and a lack of empathy for (and even exploitation of) others. Personality disorder characterized by excessive self-love, egocentrism, grandiosity, exhibitionism, excessive needs for attention, and sensitivity to criticism.”

Dare I write that I have have been “helped” by psychiatrists who showed “egocentrism, grandiosity, exhibitionism, excessive needs for attention, and sensitivity to criticism”?

Can you link to evidence that people who are labeled with personality disorders are met with respect and empathy in the Health Services? 

I am trying to understand the difference between “mental illness” and “brain disease” in your frame. And I keep thinking of Christians who talk about a good and loving God without rejecting the vindictive and punitive God of the Old Testament. You wrote that “diagnosis doesn’t mean ‘brain disease'”. But aren’t the psychiatric diagnoses that  you are defending based on the medical model of brain disease? 

I get associations to the geocentric model of the universe; the image here is from a Wikipedia article on Johannes Kepler: 

From a context of my life and experience, the braincentric concept of mental illness is just as muddled as this drawing … and your thinking about this also gets muddled too – like when you wrote that: 

It’s quite strange, quite sad I think, that after decades of anti-stigma campaigns, work by charities like Mind, so many confessions of mental illness and progressive government policies that some people still doubt mental illness even exists. 

In part 2 I  asked: “Why did you use “confessions”, with its judgmental undertones of wrongness, shame and embarrassment, instead of a neutral word like narratives?”

It’s qute strange, quite sad, that a psychiatrist uses the word “confessions” in the same sentence as “anti-stigma campaigns”. 

The following paper has information about professional prejudice:  

Caseness and Narrative: Contrasting Approaches to People Who are Psychiatrically Labelled by Michael A. Susko

With naming comes a transfer of ownership of the person’s mind and body to the professional. 

What Susko call “caseness” is my reason for rejecting the concept of psychiatric illness. And substituting “brain disease” with “mental illness” does not remove that.

When you write that the concept of mental illness “allows them to learn about their difficulties and help themselves”, there is an assumption that this frame of mental illness is the one and only frame. 

What about those of us who are cannot or will not join you in this frame?

Quoting Eric Maisel:

The question is not, “What is the best definition of a mental disorder?” The question is not, “Is the DSM-5 definition of a mental disorder better than the DSM-IV definition of a mental disorder?” Those are absolutely not the right questions! The first and only question is, “Do mental disorders exist?” The phenomena certainly exist. The birds and bees exist; pain and suffering exist. But birds do not prove the existence of Gods and pain does not prove the existence of mental disorders. Let us not play the game of debating the definitions of non-existent things. Let us move right on.

As I see it, the concept of mental illness is a belief system, useful for people who fit into it, in the same way that religious concepts are useful to people who fit into them. I have no need to convert others to my non-belief, I just expect respect for it … both in religious frames and in psychiatric frames. And I give myself the right to notice when non-belief is not respected. 

In part 1 mentioned ignorance about frames as one cause of psychotherapeutic dehumanisation. My word for “caseness” is “story invasion”, and to me, the well-meant invasion of psychotherapeutic stories reopen earlier wounds of societal dehumanisation and invasion. 

My experience, and the experience of others, has been that psychiatrists (and other psychotherapists) invade us with an explanation of our difficulties that has been filtered through their cognitive frame. Like the therapist who told me in the 1970s that I just had to “stop believing those feminists”. Luckily that one did not have the power to influence the health services with his explanation of why I rejected his help. 

Here are some links to information on psychiatric illness and stigma. I’ll be adding to them as I find more information, and if anyone knows of research that shows that the concept of mental illness removes stigma, I’ll be pleased to add that too:

Harold A Maio: We no longer talk about ‘the’ Jews. So why do we talk about ‘the’ mentally ill?

Mental health stigma: convincing my mates I was still ‘me’ was almost impossible

CBC: Stigma of mental illness a ‘disturbing’ trend in workplace

Is Being “Sick” Really Better? Effect of the Disease View of Mental Disorder on Stigma Mehta, Sheila; Farina, Amerigo (The discussion is on page 11-13)

Ben Goldacre in the Guardian:  
A genetic cause for ADHD won’t necessarily reduce the stigma attached

Scientists who believe that labelling mental health problems ‘an illness’ will reduce prejudice may find the opposite is true

Effects of a Chemical Imbalance Causal Explanation on Individuals’ Perceptions of Their Depressive Symptoms
Joshua J. Kemp, M.S.a, James J. Lickel, Ph.D.b, Brett J. Deacon, Ph.D.a,

  • Depressed participants received a bogus test of their neurotransmitter levels.
  • Participants received a chemical imbalance (CI) or no CI causal explanation.
  • The CI explanation did not improve self-stigma (blame).
  • The CI explanation worsened perceived self-efficacy and prognostic pessimism.
  • Medication was more desirable than psychotherapy when a CI explanation was given.

Returning to this:

DR LANGFORD: Using the word illness, not just “problems”, ensures that society treats people with mental illnesses with the respect they deserve; not just lazy, peculiar, and malingering.

In my frame, knowledge about societal harm shows that people are “not just lazy, peculiar, and malingering”. I have written about this in part 3.

And in that frame no one has to “read psych journals to see the science used”, they can think for themselves and connect information about societal harm to their own observations and experience. 

It is so beautiful, that lightbulb moment when a “normal” person suddenly realizes that a weird schoolmate or neighbour, colleague or relative just has visible symptoms of something harmful that happened to them. 

And in my frame there is no need to know what happened. 

Something has caused the harm, and the responsibility for that belongs to the cause of the harm. 

And the person who carries the harm owns responsibility for dealing with it – hopefully with respectful, constructive help from professional mental helpers who have the guts “… to stay unsettled in order to look at, not past or beyond, the subject. To stay in the not knowing and trying to know with the subject …” (LEANH NGUYEN)

It is that simple. And that difficult.