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On the possibility of honesty: report from the foundation for mental health excellence

Posted Oct 03 2011 2:37am

Linda and I have just returned from the fall symposium of the Foundation for Mental Health Excellence.  Robert Whittaker spoke at dinner the first night.  His topic was simple.  The possibility of honesty in the mental health system.

As he spoke I thought of many things.  I thought about the people I knew that had been cured in hospitals by lack of insurance.  I thought of the people I knew who had been admitted with a primary referral behavior of good insurance.  I thought of doctors who thought everyone had bipolar and doctors who thought no one had bipolar.  I thought of doctors who thought everyone needed the medicines they liked to prescribe the most.  I thought of patients who had been told they were resistant or unmotivated because they  dared question what a doctor had told them was best for them.  I thought of doctors who routinely told people that they would never get anything out of life and thought they were being kind by destroying any hope that their patients had.  I thought of a mental health system that trumpeted its knowledge and skill, but yet couldnt convince half the people that needed help that they were worth going to .

And I realized that we ask the wrong question.  We endlessly debate who is right and who is wrong.  That is ultimately a turf question.  And no one tends to accept a challenge to their turf.  No one likes for the entitlement of their position and opinion to be brought into doubt.  I wonder how much of the debate about mental health is really little more than a turf battle?

I have one friend right now who is destroying himself to prove he is right.  He has been a tireless mental health advocate for many years and has literally helped thousands of people.  He has decided that he needs to stop taking medication because it is wrong.  He is passionately committed to that position.  It defines his turf.  He is slowly and surely falling apart.  I have heard people who before speak only in admiring terms of him now talk about him as delusional and old way before his time. 

I know of one doctor when his patient described what she was sure was akathesia and told him it was driving her “crazy” respond by saying your right, but it is really controlling your symptoms so lets increase the dose.  He was the doctor.  He was right.

I think the real question is not who is right, but what works.  That was what I think Whittaker was talking about.  Let build a system built on truth guided by the answer to one question.  “What works?  What really helps?”

It would I think be a really, really, really different system.

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