Peggy-Sax 2Peggy Sax; January 3, 2011

James, it’s my understanding that you have been absorbed in the last few months studying studying with the interdisciplinary group at your local university about the nature/construction of mental disorders” and “working with the ‘difficult client” (i.e. working with the difficult aspects of the therapist in relation to the client’s presenting issues and behaviors).” Maybe you could get us started? What can you tell us about your recent experience?  What did you learn? What are some of the hard questions raised? What do you want most of all to bring forward to influence your practices?

kevinN-150x150 2Kevin Nielsen: January 5, 2011

These books look fascinating.  It reminds me of an observation that Foucault apparently made how the rise in the number of mental health professionals overs the years corresponded to the rise of mental health disorders.  It’s an important area to explore.  At one time runaway slaves were thought to suffer from a diagnosable disorder.  I look forward to looking up these links and exploring this topic further.



Mohammad-Arefnia-150x150 2Mohammad Arefnia: January 11, 2011

Happy New Year Everyone,
Snow has been forecasted for Baltimore and a lot of people have cancelled their appointments way before its arrival- if it shows up. So, I have a bit of free time today and can say Hello again to you all.

I think about the ways in which globalization is profitable for some. Convincing even small segments of large populations, let’s say in India-where most psychological approaches to human dilemma were perhaps first devised and have been practiced for thousands of years, some of those approaches now used widely in treatment of trauma, i.e. yoga and mindfulness meditation (see van der Kolk)- that their indigenous approaches are lacking the “scientific validity” that medications, antidepressants for instance, possess, can translate into huge profits for pharmaceuticals.

Here is an article about the soon to come DSM 5 that sheds some light on the politics of diagnosis:

Inside the Battle to Define Mental Illness

All the very best to you all in this New Year!

Peggy-Sax 2Peggy: January 12, 2011
First of all, WELCOME BACK! I also spent some time on the phone this morning with a woman in Baltimore getting you properly registered from the David Epston event here in Vermont in June. I’m so happy you are coming!

Today is a snowy day. I had 9 client hours scheduled and only 3 actually filled. This gave me time to sit with your post and to follow the link to read more about Allen Frances’ defection from the DSM in  “Inside the Battle to Define Mental Illness.” I really wonder what it is like for  Allen Frances to speak his truth now in ways that alienate him from his prestigious past. I think this is courageous.

Combined with “Crazy like Us” and “Anatomy of an Epidemic,” the politics of diagnosis is rather bit depressing, isn’t it? As a US citizen, I feel a particular sense of shame about the spread of influence of the pharmaceutical industry, corporate interests in profit, and “export’ of psychiatric diagnoses throughout the world and even into indigenous cultures. The one shining light for me is having a sense of solidarity with others (such as in this study group) or are willing to think beyond black and white, and to inquire into what might otherwise be seen as “sacred ground.”

Keep with us, Mohammad. I’m so glad to see your name come across my screen!

kevinN-150x150 2Kevin: January 19, 2011

Hi Mohammad!  It’s good to hear from you.  I appreciate you posting this link and  I look forward to reading it.  I have been thinking of you as well as the struggle of working with DSM as I get ready to start my new job.  It will be as a therapist in a medical clinic and I will be required to diagnose. I have a fair amount of unease on different levels.  It is depressing just how prevalent all this is.  I agree with you Peggy that it is great that this study group offers a place to go beyond black and white, to be challenged and move towards more accountability and ethical conduct.

Just yesterday I was watching an online a BBC documentary called “How Mad Are You?

It was quite fascinating.  There were ten volunteers, five of whom had been given diagnoses and had received psychiatric services and five had not.  They spent a week together engaging in different activities and partaking in different psychological tests while three psychiatrists observed them to see if they could determine “who was mad.”  It was very thought provoking.


Italo-Latorre-Gentoso 2Ítalo Latorre-Gentoso: January 12, 2011


Someone know about Spanish resources on this topic?



Mohammad-Arefnia-150x150 2Mohammad: February 7, 2011

Hi Peggy,
Hi Kevin,
Hi Everyone,

A young woman has been coming to me for consult for a year now-Fridays at five. She was in the clutches of her “old friend”, anorexia, starting back in her teen years for which she went through a variety of therapies, some rather strange and inhumane, when she lived in Europe.
She has been taking Lexapro, a newer and more popular, much more expensive antidepressant, an SSRI, which is a close offshoot of another SSRI, Celexa manufactured by the same company. There has been a generic for Celexa for a while now at the rate of $4 for a months supply as opposed to Lexapro which is still under patent and costs more like $120 per month.
We saw the psychiatrist last week and talked about reducing the dosage she is taking. She did not know what to do, hesitant to possibly lose what she has accomplished. Afterward when we returned to my office with a three month prescription of the same dosage she posed this question: “I don’t know if that which I have accomplished has had anything to do with the medication or rather it has been due to our conversations?! For one if the medication is working how come I still continue to feel anxiety?”

I am biased. I think it is the conversation that has helped her begin to “see” again and rekindle an image of herself that had been obscured, buried even. For years an image of “illness” had been reflected back at her and dominated her perception of herself and the way those around her also perceived her.
Through our conversations we have wondered why? Who also conspires to uphold such stories? Who benefits?
Even if there are no medications involved, the hierarchy is maintained by having the “subjects” view themselves as “less than”, as deficient and ill and they themselves being the source of their own misery. “Self-subjugation” is the greatest accomplishment of the upholders of the dominant story.
Women, we have discovered together, were told in her society that they would be crazy to try to shake up the status quo.  “Why give up the cozy comfortable arrangement and reach for a higher degree? Stay where you are with the rest of us and be happy, barefoot and pregnant.”
Makes me think of the diagnosis of Drapetomania, the supposed mental illness that plagued the Runaway Slaves, coined by Samuel Cartwright, it posited the slave would have had to be deranged to want to leave the security of the master’s plantation and be free!

Mary-Brevda_profile-150x150 2Mary Brevda: February 20, 2011

Hi Mohammad, I have thinking about your post fort a while and meaning to respond. Thank you for helping me find it! I was drawn to it both the issue of meds and where they play a role and also the topic of anorexia. It is always so hard to know how much the drugs helped and how much the therapy helped. Sometimes the doctors push the drugs and I have been in a position where I have worried that the doctors questioned my competency as I was not talking to my client about meds when they thought the client needed them. IF a client wants to try it without medication I will work with them and support them to do it without meds. I have also been in the position where I have wondered if it was really the meds that helped them get better and not the therapy! So often it seems that one can never know what it is , for they turn a corner and I can only guess that it is a combination of all the things that they have done. I am imagining that you must have felt really good about your conversations in that you thought it was more that than the drugs. That leads me to want to ask you about these conversations. What kinds of questions did you find most helpful? Were you aware of the particular conversation that seemed like a turning point? What did you find helpful and what was not as helpful?

I am working with two young women who are struggling with anorexia so I have a particular interest in what helped in your situation. I was struck by the powerful hold anorexia can have after a recent conversation. We have talked about the hold anorexia has on her, what the voice of anorexia says to her, the societal impact, and other things but anorexia has such a tight hold. This young woman cried so hard when she was given a free T shirt after buying sneakers. She was given a size medium and this young woman was beside herself that the clerk saw her as a medium. Her sister is the same size as her, but not captured by the same obsessive  thinking about everything she eats and is just naturally thin and eats whatever she wants where my client thinks about it all day long. She kept saying it’s not fair that she(her sister) is that size and is so free. My client is not dangerously thin, but plagued by worry about her size. Anyway, if you(or anyone else) have any thoughts I would welcome them. —Thanks ! Mary

Mohammad-Arefnia-150x150 2Mohammad: February 20, 2011

Hi Mary,
Anorexia is an old friend, an ally she employed to help her take a stance against the tyranny she was experiencing, one that was imposed on her by her family and her society. Though the Anorexia itself became tyrannical and nearly took her life she does not see herself on the opposite side of it, nor do I. I see her having the willingness to give up her life for the freedom she very much desires to bring about in her life. She wants to be free from self criticism, from comparing herself with others, from viewing herself as less than, from the gossipy talk that her family engages in, casting themselves apart from others by noticing the short comings of others as a way of taking notice away from the constant nagging of the “mal de vive”, the not good enough that they have learned to experience themselves through as she does, the not good enough that has been upheld by societal forces through ages, as in women do not need to waste their time getting an education beyond home economics, cooking, sewing, and child rearing.

I see her employment of anorexia as the expression of her personal agency, as her way of standing up for herself and what she believes in, her way of saying listen to me and do not dominate the conversation. That she was willing to be dominated by anorexia in order to fend off domination by others-perhaps her father and the patriarchal establishment- is akin to the animal who gnaws away at its limb caught in the trap so to limp away to freedom. Our conversation is about why and how this freedom is important to her, what it may look like when she embodies even more of it, what will she be doing as she inhabits the life that is imbued by her ability to express herself freely and ultimately the need and her own wish to be healthy and fit to realize her dream of that different life she envisions for herself.

We talk often about a pivotal and unique event in her life, the time that she took a “leap” across the English Channel and in her excitement drove on the wrong side of the road even toward pursuit of her dream of becoming a scientist and what it took to bring it to reality. The struggles along the way and how she alone was able to face them. Much is about development and scaffolding horizontally to help her acknowledge her personal agency. We talk about the falsehood of a claim a colleague had once made that he could give her self confidence and self esteem and her realization that self esteem can not be given nor can freedom that only she can claim hers. We talk about the “I” in her and the importance of expressing herself using the power of “I” as in the “I beam of her spine”, poised to announce to the world that here she is with her piece of the puzzle, her contribution toward understanding this riddle.

Italo-Latorre-Gentoso 2Ítalo: February 21, 2011

It is great to have this videos! I saw them since a time also with others in Spanish and I really love them. The thing I don’t like about the “The Marketing of Madness: Are we all mad?” or”El Marketing de la Locura: ¿Estamos todos locos?” is its audiovisual treatment, more specifically in the music, I think the message is so important that don’t need that music. I am telling this thinking in how (this music for example) can wake up prejudices in those who are working with structuralist ways, something like ‘the bad ones and the good ones’. I think this is a theme that we have to speak with profund respect with all practitioners without forgetting that there are a majority using structuralist ideas.

For me the pharmaceutic theme and all the lies for having very millionary incomes, is something I can not accept in any way, despite of this, I think many psychiatrist are very interest in helping people and working with respect (in their understandings of this) and the risk is outing all practitioners in the same bag (this is a chilian expression ‘meterlos a todos en el mismo saco’)

Despite, I love the content of these videos and really appreciate the second one! Is very powerful and its audiovisual tratement is very congruent with respectful practices.

Sorry for these distinctions is because my audiovisual training that I highlight these details.