Here's a 🧵on @awaisaftab's proposals for DSM 6. While presented as reformist, they leave the core logic & ideology of the DSM intact, doing nothing to correct the systemic harms caused by the manual. Here's why his proposals will, in essence, enable more of the same👇 The categorical diagnostic framework remains unquestioned, while there's no serious challenge to the DSM’s authority to arbitrarily define, partition & pathologise what it frames as 'disorder' - a term he protects via redefinition. 2/8

A short 🧵on how therapy works. Firstly, the kind of therapy (CBT, humanistic, psychodynamic, etc) does not solely determine outcomes. Research shows that *common factors* shared across therapies account for the majority of any improvement. Here’s what that research tells us👇 2/ e.g Research by Michael Lambert’s et al (based on dozens of metaanalyses) breaks down the influence of different factors on good therapy outcomes:
40%: Client factors & life circumstances
30%: Therapeutic relationship
15%: Expectancy/placebo effects
15%: Technique or method

🧵 What do SSRIs really do to your emotions?
A major Oxford study (by researchers supportive of antidepressants) explored the lived experiences of SSRI users (experiences not captured by RCTs). What participants revealed about emotional blunting is disturbing… So here we go👇 1. General flattening of all emotions: Most participants said their emotions felt ‘dulled’ ‘numbed’ or ‘blocked’ by SSRIs. Some couldn’t feel at all, and just thought about how they should feel. Even joy, grief or love often felt distant or ‘fake’....

🧵My response in the New York Times: “If you are looking at people on the drugs for eight weeks, you are not going to find withdrawal,” said James Davies... “It’s like saying cocaine isn’t addictive because we did a study on people who had only been taking it for eight weeks."👇 1/ Dr. Davies, an associate professor of psychology at the University of Roehampton in England, said he worried that the findings, “if read uncritically,” would “cause considerable harm by significantly downplaying the effects of real-world antidepressant use.”

Heads up, everyone! Something big is coming next week. It concerns psychiatry's blockbuster drug - the antidepressant. This thread breaks down what’s about to happen, why it matters & what’s at stake 👇 1. Next week a major study will be published by some of the biggest names in drug-company-funded psychiatry; many with track records of minimising antidepressant withdrawal. It’s expected to downplay withdrawal, based on flawed, mostly short-term studies - many pharma-funded.

A thread 🧵 showing why people are rightly angry about the corruption between psychiatry & pharma.

It concerns the psychiatrist, Joseph Biederman, & the 'Harvard Scandal', which helped fuel a highly damaging wave of antipsychotic drugging in children.

Here's what happened 👇 2/ Joseph Biederman was a world-renowned child psychiatrist at Harvard; one of the brightest lights of his profession. He played a leading role in popularising so-called ‘bipolar disorder’ in young children & in promoting the use of antipsychotic drugs to ‘treat’ them.

🧵Awais Aftab’s recent post on “over-diagnosis” doesn’t merely defend the diagnostic status quo; it goes a step further by portraying the DSM as “rather conservative” & suggesting it may fall short precisely because it excludes too much suffering from its ideological grasp....1/5 ...This framing reinforces the idea that all suffering requires a psychiatric meaning & that diagnostic inflation is a clincial good. It downplays the fact that previous diagnositc inflation has less improved clinical outcomes than pharma/psychiatric power & profits....2/5

A 🧵thread on why claiming 'psychiatry is just like any other medical specialty' glosses over major differences. It’s a convenient slogan; not an honest comparison. Here's why 👇 1/ Most medical diagnoses are based on objective tests (bloods, imaging, urine tests etc), while psychiatry predominantly relies on subjective interpretation of behaviour & self-reports alone, which are then matched to ‘categories’ of distress, created by committee consensus....

I recently watched the BBC documentary "Change Your Mind, Change Your Life" (it films therapists in action), & found many aspects of it frankly disturbing. Within minutes of meeting clients, therapists were making sweeping claims about their client's underlying psychology...1/7 ...as if they had some kind of mystic second-sight. Their rapid-fire 'insights' were followed by simplistic, take-home exercises offered as quick fixes & giving the impression that healing is a kind of formula to be rapidly appllied rather than process to be lived. 2/7

A defence mechanism I regularly encounter in the therapeutic space (but which's entirely under-theorised) is what I would term 'internalisation bias', wherein somone persistently attributes all difficulties, failures & negative experiences to a perceived internal flaw, defect... ...disorder or inadequacy, regardless of external contrary evidence. This defence oversimplifies causality by shielding the person from confronting a complex, chaotic or threatening external reality: 'It must be my fault' replaces enqiry into systemic, institutional etc causes...

🧵Why is mental health disability rising? Here are key reasons rarely discussed in mainstream media:

1️/ For decades we've neglected tackling the social determinants of societal distress, relying instead on medicalisation as a superficial ‘fix’ for downstream harms. This has... ...led to worsening outcomes as primary causes are left intact.
2/ Instead of addressing social harms, we've pathologised them. This has turned victims of enduring unjust policy into chronic patients, fuelling long-term prescriptions & treatment-induced iatrogenic disability.

"In order to escape accountability for his crimes, the perpetrator does everything in his power to promote forgetting. Secrecy and silence are the perpetrator's first line of defence. If secrecy fails, the perpetrator attacks the credibility of his victim.....1/4 If he cannot silence her absolutely, he tried to make sure that no one listens. To this end, he marshals an impressive array arguments from the most blatant denial to the most sophisticated and elegant rationalisation.....2/4

This forensic review of R. Chapman's new book, exposes Chapman's multiple hostile misrepresentations of critical psychiatry, and how Chapman's obsession with mis-labelling all critics as 'Szaszians' has blinded them to the reality of the modern movement. madintheuk.com/2024/04/empire… Chapman's ideological commitment to dismissing all critical psychiatry, to create a space for the dominance of their new 'neurodivergent marxist revolution', leads them to write out of history anything that contradicts their bias.... this review expertly exposes how that is done

'What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props & understandings are rapidly disappearing.... 1/4 ...Instead, our dominant worldview is now driven by barely perceptible capitalist imperatives: to work, to earn, to profit, to succeed, to consume. Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world...2/4

Thread 🧵. The concept of the 'faux-left' in mental health has been doing the rounds, to the extent it may warrant some unpacking. So here is my attempt. In short, ‘faux left’ is being used to describe a perspective in the critical MH community that is pro-DSM… 1/8 ...which believes that the best way (for the foreseeable future) to get social support for suffering/divergent people, is for those people to submit to psych/DSM/ICD diagnoses, as this is the surest way to access services. This 'faux left' view (or, as I'd prefer to call it...2/8

A short thread on why the far-right is not only conspiratorial but totally confused when it comes to psychiatry, antidepressants and gun control. 1/7 One the one hand, the Republican right has traditionally leveraged the medical model to account for why gun shootings occur. It says: 2/7

Hi folks, I'm delighted to say that the paperback version of Sedated will be released next week (March 10th). Sedated explores the mechanisms that've enabled our mental health sector & discourse to spread, grow & dominate (since the 1980s) despite its continued poor outcomes. 1/8 This has occurred by way of our mental health sector becoming a handmaiden to neoliberalism. The mechanisms that have facilitated the sector's economic servitude are many. Here are just three for the purpose of illustration. 2/8

There has been quite a bit of discussion on Twitter regarding emotional suffering, which one of my tweets appears to have provoked. I am glad we're having these conversations, even though I regret how easy it is to be misunderstood on this platform...1/6 I set out some of my views in a book I published in 2011 called the Importance of Suffering. There I explore forms of suffering I term productive & unproductive, and how the form any instance of suffering takes, is significantly shaped by how it is culturally responded to. 2/6

Sort thread: Rissmiller's influential article published in 2006 argued that the 'anti-psychiatry movement' (once led by an academic elite) has now morphed into a 'patient-based consumerist movement' that has evolving political power... 1/5 .... a movement that is seen by many within the psychiatric profession as “extremist”, as “having little scientific foundation” – i.e. as irrational, untrustworthy and non-professional.... 2/5

Hi folks, I'm very proud to say that my book, Sedated, is released today! I've done everything within my power to write a book worthy of your time - one that illuminates via interviews, stories & research why our mental health sector is broken & how we may put it right again. 1/5 As with my previous book, Cracked, I have widely interviewed leading politicians, activists, service users, clinicians & academics to help tell the story of how our mental health sector has evolved since the 1980s to serve the needs of our economy… 2/5

@psychgeist52 Thanks James, what you say reminds me of something I wrote a while back: "the word ‘disorder’ when understood in the above psychiatric sense... is also being used prosaically, even misleadingly, from the standpoint of the word’s original Latin root: ... 1/3 @psychgeist52 " where ‘dis’ means ‘take away’; and ‘order’ means (stemming from ‘ordinare’) ‘to order or regulate’. ‘Disorder’ therefore refers to our ‘order’ being ‘taken away’ – our internal safety and security being removed"...2/3.