‘Better Ways To Mental Health,
the impact of childhoods on the stability of society.’
Proceedings of the Seventh Annual
conference
of the
The James Nayler Foundation
York
March 2005
Published by the James Nayler Foundation
all proceeds from sales
of this book will go to the James Nayler Foundation
We were delighted to welcome about 300 participants
to our Seventh Annual Conference, held for the fourth time in York, in the
beautiful surroundings of the Central Methodist Church.
With this publication, we now have seven complete
proceedings of our annual conferences. These continue to form an increasingly useful and
vital record of innovative development in this area. They add to the record not only of the thinking of key
experts from the UK, but also the thoughts and experiences of those who have
suffered from Personality Disorders.
We are grateful to all who participated, thus
helping the positive development of the Foundation.
Sue Johnson
Preface.............................................................. 1
contents............................................................. 2
programme...................................................... 2
Sue Johnson Welcome to the Conference &
report on the Foundation . 3
Robert Whitaker ‘the Enduring
Mistreatment of the Mentally Ill.’ 5
The anti-psychotics’ story............................... 5
The
Dopamine Story........................................ 5
The
damning conclusion about our approach to schizophrenia 6
The
fascinating story of the anti-depressants.. 6
Progress ?........................................................ 7
Helen & Clive Dorman ‘Starting from day one
to make the difference ’ 8
Questions....................................................... 10
From the front line - prison........................ 12
From the front line - community.............. 14
Questions
to Tony.......................................... 16
Dr Bob
Johnson – ‘Dyadic Intimacy – Practical Attachments from Infants to
Adults’ 18
Ethan............................................................. 18
Questions
from the audience....................... 20
Are psychiatrists acting on Robert Whitaker’s
findings? 20
[Clive
in response to a question about upbringing] 20
Bob,
what has been your experience with your mother? 20
How can
people move on to being an adult,.... 21
How do we
counteract the prevalent attitudes in mental health? 21
‘Better Ways To Mental Health,
the impact of childhoods on
the stability of society.’
10-4.15 pm Saturday 5 March 2005
in the Methodist Central
Church, St Saviourgate, York YO1 8NQ UK.
programme
from 9:30 am registration & coffee
10:15 Sue Johnson Welcome to the Conference and
report on the Foundation .
KEYNOTE SPEAKERS
10:30 Robert Whitaker ‘the Enduring Mistreatment of the Mentally Ill.’
11:15 Helen & Clive Dorman ‘Starting from day one to make the difference ’
PERSONAL PERSPECTIVES
–
12.00 from the front line–
§
prison
§
from the community.
LUNCH & NETWORKING
1 - 2 pm --. Book stalls, charity stalls,
PRACTICAL ISSUES
2 pm Dr Bob Johnson – ‘Dyadic
Intimacy – Practical Attachments from Infants to Adults’
2:45 – 4 pm Panel
discussion and questions,.
4 pm summary and close.
4.15 pm tea.
Welcome to our Seventh Annual Conference. I can’t quite believe it is our
seventh. It’s wonderful support.
It just keeps growing. We
have people here from all over the country – from Scotland, from
Cornwall, from Wales, London.
I don’t now whether the people who were hoping to come from Kent are
here. Oh, you’ve made it! Wonderful! Thank you.
That’s great.
What we have really quite uniquely represented here, people
with all sorts of different perspectives, differing problems of emotional
mental distress that our Foundation is trying to do something about. It is a really rich mix of people.
In particular, I want to say a big “thank you” to those
people who have come to our conferences in a really very courageously and
inspirational way to talk about their experiences – what really does
work, what really is helpful. Sharing their humanity with us, which is
great.
But as ever I am really excited about our speakers
today. Bob is going to introduce
them because he is probably even more excited than me. I think the speakers we have are at the
cutting edge of what I hope will become a turning point in thinking about
emotional and mental distress. I
hope that our Foundation is helping to support that.
Just a few notes about your folders. They are cleverly colour-coded and they
should have been collated in order of use. The yellow one is the programme for the day. There are notes on the back. There is no smoking anywhere in the
building and please don’t bring food and drink into this main hall.
Summaries about the speakers. I think Bob has space for questions and comments. And if you feel so inclined,
we’ll leave a box on the table so you can put your questions in. Or give them to any of the
stewards about the place. These are labelled blue and just leave them on the
table. That will then form our
question session this afternoon and we’ll also record all comments and we’ll
put them in our proceedings. We
have an order form and a lilac registration of interest form, which please
complete if you want to be kept on our mailing list. Oh, importantly our latest newsletter about our recent
activities and what we are proposing to do in future. OK. Thank you,
it’s lovely to see you all and I’ll hand over to Bob.
Bob – Welcome and thank you for coming. Your support is very important to me
personally. As Sue says, I am
extremely excited about our three speakers we’ve got this morning. Robert Whitaker is going to start
off. In part of my 14½ minutes of
fame, every three years I get to review some books for the New Scientist. They forget about me in between. When I’m at a bit of a loose end in the
summer I ring them, and ask them – ‘Do you want me to review some more
books?’ Three years or so ago they
sent me a whole pile and one of them was ‘Mad in America.’ I couldn’t put it down. I read through the scarifying factual basis of what is
called, “the enduring mistreatment of the mentally ill from about 1850 and
prior to 1800”. I said to the New
Scientist editor, you have given me a 1000 words to write a review on twelve
books and I want to devote a thousand words to this one alone. She said
‘no’. But I put a paragraph in,
which I am happy to say they reproduced on the flyleaf of the paperback
edition. I’m going to read it.
“This is such an important book that every psychiatrist
should be compelled to read at least the preface, every year. And everyone else should then
insist on them describing in writing every year, what they are going to do
about it.”
And that still stands. This led me to contact Bob Whittaker and he said ‘I liked
your review.’ By way of
payback he offered to buy me a drink. Unfortunately he said I had to go to
Boston for it! Maybe I’ll take him
up on it.
It is my very great pleasure to introduce Bob
Whitaker. Bob…
Well first of all, it is a real pleasure being here in this
wonderful city. Thank you for
having me. I know the theme of the
conference is Better Ways to Mental Health. What I am really going to speak about is why we need better
ways for mental health. To put the
current paradigm of care under the microscope – to look at it. And see
what sort of results we are seeing in the US with our drug based form of care.
Bob just showed me a piece in the Economist this week
– we now say that 20% of Americans are mentally ill. That is a huge number. But what you see
in the United States is a rising trend – what we talk about now is how we
could have an epidemic of mental illness.
I am just going to give you some facts, so you can see that the era of
drug-base care dates back to the mid 1950s, when Thorazine (aka Largactil, or
chlorpromazine) was introduced, and how we see in essence the population in
fact getting less well since then.
For example, since 1955, the number of patients with severe
mental disorders in the United States has quadrupled on a per capita
basis. Our patient admissions to
mental health care programmes have increased 250% since 1969. Now these next figures are the ones
that I think are the most compelling – what percentage of the population
is unable to work due to disability?
Since 1955 the number of people disabled by mental illness in the United
States has increased six-fold from 3.383 per 1,000 people to 20 per 1,000
people. A six fold increase. So we
are seeing rising disability due to mental illness in our country.
Now let’s look at disability rates since 1987. This was the
year Prozac was introduced to the United States. We got the new atypical anti-psychotics, and the SSRIs. It’s when we got the second
generation of psychiatric drugs.
And the common wisdom in the United States is that these drugs were such
an advance on the old drugs.
So I wanted to see if we are now seeing a decline in the disability rate
since that’s what you would expect.
Yet since 1987 the number of people receiving disability payments in the
U.S. due to mental illness has increased from 3.3 million to 5.7 million. It’s increasing by 150,000 people per
year, or 410 people per day every day for the last 15 years. Now during this same 15-year period the
spending on psychiatric drugs in the U.S. has increased from US $1 billion to
close to US $23 billion dollars. A
23-fold increase in spending. And
at the same time we are getting this increased disability. So you start to see
that something is wrong.
We spend more on psychiatric drugs than the gross national
product of two thirds of the world’s countries. We spent more on antidepressants than the gross national
product of Jordan or Cameroon. So
you can see we have avidly embraced this paradigm of care but where is the
return? Where are the dropping
disability rates? And at the very
least this rise in disability at the same time we are seeing this rise in use
of psychiatric drugs raises a
scientific question. Are
the drugs in some way, in essence, increasing disability? If we go back to the research
literature, what are we going to find?
What does the evidence show us?
My background is – I was a newspaper reporter for a
long time, covering science and medicine.
Then for a while I covered the drug industry. I absolutely believed wholeheartedly in the common
wisdom. I
believed that we understood the biology of mental disorders and I believed that
the drugs were getting ever better.
That was my starting point.
Then when I started this book, I started to find things in the research
literature that raised questions about that common wisdom. So what I am going to do is go back
through the research literature on two classes of drugs – the
anti-psychotic drugs and the anti-depressants. And let’s see if, in that
research literature, there is a scientific explanation for why we are getting a
rise in disability rates. Because
that is what you have to look for.
You are going to look for confirming evidence.
Now the story of anti-psychotics is an amazing story. Because actually the evidence is
quite clear. The first study
done that attests to their efficacy was conducted in the late 1950s, early
1960s, by the National Institute of Mental Health [NIMH]. It was a nine hospital study and it had
four different groups. Three
groups were treated with an anti-psychotic; the fourth group treated with a
placebo. After six weeks, the
people treated with the anti-psychotic were indeed doing better, at least on
the target symptom of psychosis.
Their psychosis had diminished more than it had in the placebo group and
that is the moment the United States Scientific Community said Aha! We have a drug for psychosis. We now have something specific, sort of
a magic bullet for knocking down psychosis. And that study, by the way, is still cited today as one of
the reasons we know these drugs are efficacious.
But what happened when researchers went back a year
later? What did they find? They found that the placebo group was
less likely to be re-hospitalised than any other treatment group. So from this very first moment of our
research into anti-psychotic drugs you see a paradox – you see
short term benefit: long term increased chronicity. Right
from the kick off. So
this raised some questions. So now
researchers did what are called relapse studies, and again this was done by the
National Institute of Mental Health, our best scientists. What they did with the
relapse studies is they would withdraw the drugs. They would have people diagnosed with psychosis or schizophrenia
on the drugs and then they would
withdraw the drugs; and the researchers grouped them according to the drug
dosage they were on before
withdrawal.
What did the researchers find? They
found the more drug you were on before withdrawal, the greater the likelihood
of relapse, that the psychotic symptoms would return. Do you know who had the lowest relapse rate? The placebo group, the one that was on
no drugs at the start of the study.
And it went up statistically significantly – the more drugs you
were on before withdrawal: the greater the relapse rate.
So what does that mean? Well that fits the first study – that the drugs in
fact were causing some changes in the brain that were predisposing, even
increasing your biological vulnerability to psychosis. Now this study was done in the
late 1960s and it was so surprising that the researchers repeated it. What did they find? Exactly the same thing.
So this raised a real concern. So now in the 1970s, this question of the merits of
antipsychotics was still
open, and so NIMH-funded
researchers ran three more studies. They took newly diagnosed patients with
schizophrenia and treated them conventionally with drugs or else in an
environmental situation without anti-psychotic drugs. These studies run by the head of schizophrenia studies
at the U.S. NIMH, by researchers at NIMH facility in Maryland, and by
investigators in California. Now the studies produced results that were
interesting for two reasons.
First,. in each study, the
long term ‘stay well rate’, the ‘non-relapsing rate’, in each case was very
much better with the placebo group, the non-drug group. Each time there was a greater
chronicity, a greater return of psychotic symptoms in the drug treatment group,
over a one to three year period.
The other thing that was interesting was that in each one
of the groups where they took newly diagnosed people and didn’t treat them with
drugs, more than 50% got beyond their bout of schizophrenia, got better and
were functioning well enough that they did not to need to be in hospital or in
an institution. They were
functioning, stable. This was the
researchers’ definition of ‘stay
well’. What is so intriguing about
that, is that it presents schizophrenia in a new light. It’s not that you have
this schizophrenia and that’s it, and that you are never going to get better
ever. In fact, many people diagnosed with
schizophrenia or psychosis got better, and a greater number of people got
better if they weren’t treated with drugs initially. And that was consistent across all three studies.
At the same time, researchers confronted with these
outcomes asked, what is going on?
And they put together the puzzle, and came up with a biological reason
why the drugs made people chronically ill.
Here’s the story: – These drugs were standard
anti-psychotics, which dampen down dopamine, very powerfully. Dopamine is a chemical messenger in the
brain. And these drugs block that
messenger – they blocked about 70 - 90 per cent of the dopamine receptors
in the brain. And once researchers
understood that, by the mid 1960s, they theorised that schizophrenia is caused
by too much dopamine – this is the dopamine hyperactivity hypothesis,
formulated in the late 1960s early 1970s. So they investigated that
hypothesis. And the way they
investigated it, was they looked for metabolites, break-down parts of dopamine
in the cerebral spinal fluid, and in blood and urine. And they found that people with schizophrenia have too
high levels of these breakdown products. ‘We’ve found the cause of
schizophrenia – it’s too much dopamine’.
However, the researchers included a caveat: “We don’t know
if it’s due to the disorder – or due to a reaction to the drug”. They said they would do more research
and what did they find? That
non-medicated people diagnosed with schizophrenia were normal. The medicated
people is where you get the
abnormal levels of metabolites.
The researchers figured out what was going on. What happens is the brain, being an incredibly adaptive
thing, finds the dopamine blocked, and says, ‘oh no I need this chemical.’ So it starts pumping out
more dopamine. It’s a
compensatory mechanism, and it lasts for about three weeks. It’s an example of the brain trying to
compensate for the drug. So the
researchers said, well, if people with schizophrenia don’t have too much
dopamine, maybe they have too many receptors. Maybe that’s the cause of
schizophrenia..
So what did they find. They found that their psychotic or
schizophrenia patients had an abnormally high number of dopamine receptors in
their brains—about 50% higher than normal. And again the New York Times,
reporting on that research, said
the cause of schizophrenia has been found. But you need to read the research papers. Once again the
investigators confessed, ‘We don’t
know if it’s due to the drug or the disorder.’ So further research was done and this was what they
found. In un-medicated people,
there was no abnormality; it was only in the medicated people. Again it was a compensatory mechanism
in response to the dopamine blockade.
The brain increased its number of dopamine receptors in order to adapt
to the blockade of dopamine by the antipsychotic drug.
By 1979 this story of biology had been put together by
Canadian researchers, and they had come to this horrifying conclusion. Here’s what they wrote. They wrote, “Neuroleptics can produce a
dopamine super sensitivity, that leads to both dyskinetic and psychotic symptoms. An implication is that the tendency
towards psychotic relapse in a patient who had developed such a
super-sensitivity is greater than it would be otherwise in the normal course of
the illness.” And the point is
that everybody on these drugs develops a super-sensitivity, it just happens as
a matter of course, it is the way the brain responds. So by 1979 we had put this story together as to why we see
this great chronicity in drug-treated schizophrenia patients.
Now, since then, has there been any confirming evidence,
because this is so contrary to the common wisdom. This has come in a couple of ways.
First, the World Health Organisation at this time was doing
comparative studies of long term outcomes of patients diagnosed with schizophrenia
in the poor countries of the world, India, Columbia and Nigeria, versus the
rich countries of the world the UK, USA etc. And what they found each time was a very different
course of outcome. And by
the way, people were being diagnosed by western doctors, and what they found
was that in poor countries of the world about 60-65% of the people had pretty
good outcomes. Only about
35% became chronically ill.
What happened in the US and the rich countries? The overwhelming majority remained
chronically ill. The first time
they carried out the research, the western doctors said ‘this can’t be,
something’s wrong.’ So they
repeated the tests and even repeated the initial diagnostics where they broke
down the patients into six different groups with different sub types of
schizophrenia. And each time
the exact same finding. And
the researchers concluded, and this I think is one of the most damning
conclusions you’ll find in scientific literature, they said “A strong predictor
that you will never fully recover from schizophrenia is living in a developed
country.’ That is the strongest
predictor.
That is an absolutely damning conclusion about our approach
to schizophrenia. And the most
important point is, what is the
difference – what is the variable—in care in the rich and poor countries
of the world? The researchers hypothesized that the variable must be the drugs. In the poor countries of the world they must be good at
taking their drugs! They’re more
compliant. But what did the
researcher find? They found that
in the poor countries of the world, only 16% of patients were regularly
maintained on the drugs, whereas in the rich countries the patients were
regularly maintained on the drugs.
Now this study was funded almost entirely by the United
States. And the
researchers hypothesised that drug
use was the variable that’s causing the shift in outcomes. But once they found that patients in
the poor countries, where the outcomes were better, weren’t regularly kept on
the drugs, the researchers dropped this line of inquiry. They would no longer
consider that variable drug use could be the factor that was causing the difference.
A second piece of confirming evidence came from Harvard
researchers who studied what happened to patients gradually withdrawn from
antipsychotic medications. They could only eight gradual withdrawal studies
that had been done in the past 35 years.
It’s a form of care that’s
hardly been investigated.
But they found that in those gradual withdrawal studies, 35% of the
schizophrenia patients relapsed and went back into psychosis, into a worsening
condition in the first six months.
But 65% stayed well.
And the researchers
concluded the 65%, once they made it through this six month withdrawal
period, had an excellent chance of
staying well indefinitely. So the
research showed once again that you could get off the drugs. And that there was at least
a sub-population of people diagnosed with schizophrenia—roughly
two-thirds of the people so diagnosed-- that could do well without the drugs.
Another important study was run by a woman called Courtney
Harding in the US. She followed people diagnosed with schizophrenia, and who
had been on a back ward of a Vermont hospital in the 1950s, perceived as
hopeless without any chance of getting better, and she looked at where they
were 25 years later. And surprisingly, she found that approximately 1/3 were completely
recovered. They were doing fine,
no symptoms. And what distinguished the 1/3 that had completely recovered what they had all weaned themselves off
the drugs.
There was also a study done by researchers in the
University of Pennsylvania. They used
MRI’s [brain scans]. They took
people newly diagnosed with schizophrenia, and they wanted to observe whether
there were changes in their brains over the next 18 months. They put people on
drugs and they found that over an 18 month period, that as you dosed up with
the neuroleptics, you got an enlargement of the basal ganglion, which is a
dopamine region of the brain. So
you see this morphological change over time in response to the drugs. And the
researchers found that over this 18 month period, as this change occurred in
the brain, you saw a worsening of symptoms, of both positive and negative
symptoms of schizophrenia.
So this is a very powerful study. An outside agent is given to a brain, the brain undergoes a
change in response to that drug, and you end up with an abnormal brain. And as that happens, you
see a worsening of the very symptoms you are trying to treat. That was recorded in 1998.
But what happened to this line of research? The NIMH cut
off funding for it. Instead, the NIMH gave the very same researchers a grant to
develop a permanent Haldol [antipsychotic] implant that you put into the brain
so the drug can be released steadily over time. Again the NIMH showed a lack of
a willingness to pursue findings that are so upsetting to the common
wisdom.
This goes back to the disability question that we
raised. In what way
might neuroleptics contribute to rising disability rates? The point is if you take people newly
diagnosed with schizophrenia and you don’t immediately put them on drugs, some will recover. Some will get better. If you look through the literature,
it’s somewhere between 40 and 65% who will get better. In the poor countries that’s basically
what they saw – 65% had good outcomes. But our standard of care basically condemns people to
a chronic life of illness. And that explains the shift in schizophrenia
outcomes in our country compared to outcomes in the poor countries. Basically everybody given the drugs and
maintained on the drugs becomes chronically ill. Our drug-based paradigm of care blocks recovery.
Think of this with the neuroleptics. We know they have all sorts of
problems, the side-effects, the Parkinsonianism, the obesity, the early death,
the cognitive decline etc. If you
don't have an advantage on the target symptom of psychosis – then where
is the rationale for long term use, given that we know the drugs can cause such
side effects? It’s not there, at
least not across the board.
So is there anybody who’s taking this evidence in ? And running
a program saying ‘maybe we shouldn’t be medicating everybody’. Yes, there’s a guy named Allen in
Finland. In 1992, he said
“we don’t want to put people on drugs unnecessarily, so let’s see with our
newly diagnosed schizophrenics, if we can get them through this break, without
putting them on neuroleptics. If
we can’t, then we’ll use the drugs.”
What I like about his programme is that it’s not dogmatic – it’s
not saying ‘no drugs’, it’s ‘how do you use the drugs to get the best overall
outcomes’. His five year results
were – 40% of the patients have never been exposed to a single dose of
neuroleptics, after 5 years. His
relapse rates between years 2 and 5, only 12% of patients have ever gone back
to the hospital. More than 50% are
working. I don’t know about the UK,
but this is not the result we get in the United States. Basically people with a diagnosis
of schizophrenia tend not to work – only 10% do – they tend to
cycle in and out of hospitals.
So there is a programme that looked at this body of
scientific evidence, and said ‘we should be using these drugs selectively. And
we should be trying two principles – trying to avoid immediate use of the
drugs with patients newly diagnosed. And then, of those patients put on the
drugs, then giving them at some point a chance to gradually withdraw from the
drugs. Now, with this selective use of neuroleptics, you still would end up
with a group of patients that apparently needs the drugs. But you would be
giving everybody a chance to escape, to get better, and to not have a life on
the drugs. And what you see is many people off the drugs getting better. Again, this is one way our paradigm of
drug-based care leads to greater disability—it blocks recovery among
those who could do well without the drugs.
The anti-depressants story is really fascinating. The first group of anti-depressants
came to market in the 1960s and 1970s.
Generally in the early trials, the anti-depressants would be slightly
more efficacious over the short term than placebo. It varies but maybe 46% of patients would respond to
the drug (this is the old tricyclics), 31% respond to placebo. But then researchers set up a very
interesting study. They did
studies that involved comparing an antidepressant with an ‘active-placebo’, which is some thing that causes a
physiological reaction, such as a dry mouth. The idea was that without an active-placebo, the doctors
really knew who was on drug, and who was not on drug, and so there was a subtle
bias in the reported results. But
once you had an active-placebo, it wasn’t so easy to know. Guess what happened
in those studies? The efficacy of
the antidepressant disappears.
If you compare active placebo to an anti-depressant, the response is the
same.
That led to a big study by the NIMH in the 1980s. The researcher had two questions. One
was over the short term, how do drugs compare with placebo and with
psychotherapy? And two, what are the comparative outcomes over the course of a
year? Over a six week period there was no difference in any of the treatments
– the improvement in the drug-treated group, the psychotherapy group, and
the placebo group was the same. But by the end of a year, there was a
difference in outcomes. The ‘stay
well’ results were best for the psychotherapy group. And guess which was the worse ? The drug treated
group. They had the lowest stay
well rate.
Then the researchers did some further analysis, where they
looked at study drop outs, where people couldn’t tolerate the study. Here’s what they wrote – ‘if
study drop outs are included in the analysis the results look even worse. Patients receiving the anti-depressant
were more likely to seek termination of the initial six week treatment period,
produced the highest probability of relapse and exhibited the fewest weeks of
reduced to minimal symptoms during the follow-up period.’
An Italian researcher, commenting on this result, said, ‘it
appears that the drugs worsen the progression of the disease in the long term
by increasing the biological vulnerability to depression.’ He subsequently analysed 27 different
studies and in 2003 reported that ‘whether one treats a depressed patient for
three months or 3 years it does not matter when one stops the drugs. A statistical trend suggested that the
longer the drug treatment – the higher the likelihood of relapse.’
So again, with the antidepressants, you start to see the
same thing as you did with the neuroleptics. You may get some benefit over the short term. But over the long term something
is happening where the drugs cause changes in the brain that actually increase
your vulnerability to the very target symptom you are trying to treat.
There is another pathway to disability with the SSRIs. If you go back to 1987, with
Prozac arriving, we see the number of disabled people in the US increasing
since then by about 150,000 per year.
Now researchers had looked at admissions to psychiatric emergency rooms
during this period, and they found 8% of all admissions were due to psychosis
or mania induced by SSRIs (that’s Prozac and that class of drugs)– in
other words a bad reaction to an antidepressant. That’s almost a million people per year in the United
States coming in to a psychiatric emergency room because of anti-depressant
induced mania.
Now the rate of mania with SSRIs is not quite clear –
it’s between 3 to 5% Think about this, and this goes to why we are getting this
rising disability. Let’s say it’s
3%. When someone has a manic
reaction to an SSRI, they go to the hospital, and at least in the United
States, they get a new diagnosis.
This new diagnosis is bipolar.
Once they are diagnosed with bipolar, they are usually prescribed an
anti-psychotic, as well as an antidepressant. All of a sudden they are on a
cocktail of drugs.
You give someone an anti-depressant, they have this manic
reaction, and the next thing you know, they have got a worse diagnosis and are
on a cocktail of drugs, and they are now on the path towards disability. This is the real problem with the
incredible use of anti-depressants, people with manic reactions – the
next thing you know, you get this explosion of bipolar illness. All we talk about in the US is how we
have this epidemic of bipolar illness. Everybody is bipolar. Bipolar used to be rare, but now it’s between 4 and 5%. You can definitely track this back to
wide use of anti-depressants.
The story out there is that we are making all this progress,
with these wonderful new drugs, we’re getting so good at diagnosis. But let’s look at this from another
angle. What is happening to kids so treated? In the US, in 1992, the drug industry was holding seminars
about expanding the markets for psychiatric drugs. They said we have an ‘untapped population here that we need
to sell our drugs to’. They
were holding conferences on marketing drugs to kids.
Well, they’ve been incredibly successful. We’ve seen the soaring use of
psychiatric drugs among kids in the United States. And there’s a couple of things that are very
interesting. 15 years ago we
didn’t have juvenile bipolar illness in the United States; it was so rare as to
be almost non-existent. Now
it’s all over the place. How come
we have this epidemic of childhood psychiatric illnesses? So go back to 1992, and it's more
confirming evidence. First the marketing impetus, and now we are seeing
increasing childhood psychiatric problems.
In conclusion, I don't want to come across as an anti-drug
guy. I actually believe, if you
think about them properly, cautiously, then they can have a use. But in the US we’ve told ourselves a
fake story. And the fake story
we’ve told ourselves is that mental disorders are caused by a known biological problem – and these drugs
help fix that problem, like an anti-biotic. The metaphor people have used is that the drugs are like insulin for diabetes. It is just not true.
Indeed, a
neuro-scientist from Harvard University in a paper called ‘A Paradigm
for understanding psycho-tropic drug action’, said that ‘all these drugs perturb normal neuro-transmitter
function. In response to this
perturbation, the brain goes through a number of compensatory adaptations, such
as changes in the output of neurotransmitters, the density of receptors and so
on. The result is that after a
period of time you end up with a brain that is operating in a fashion that is
both—and these are his words—‘qualitatively and quantitatively
different from normal.’
So that’s a paradigm for saying you are producing an
abnormality in the brain. Now
again, there can be a rationale for these drugs, treating short term symptoms
that way. Indeed, if you
look at schizophrenia, some people need to be on long term neuroleptics. But once you understand the scientific
literature, and look at the drugs in a critical way, you can only conclude
that we need to use the drugs
sparingly, cautiously, and that we need to try other things. We need to try and
get people off the drugs.
What we are
seeing in the United States is the total failure of the drug-based paradigm of
care. 410 people every single day
newly disabled by mental illness, they cannot work. That tells you we need change. Whether it’s going to come, I don't know. But in conferences like this, maybe you
have ideas of other ways of treating mental distress besides relying on this
medical paradigm, which from my point of view has shown itself to be a complete
and utter failure.
Thank you.
Bob – Thank you. It’s fantastic.
It’s fantastic. When you’ve
spent so much of your working life in a type of Alice in Wonderland, and then
you hear the truth. It’s
just stunning. I just want to make
two comments. When I was a very junior
psychiatrist, I trained in London, where they had very wonderful old Victorian
medical records, almost A3 size. We used to get enquiries from insurance
companies wanting patient’s information, and we would skip through the pages
and find a rubber stamp with ‘schizophrenic’ on it. Once we found that, that was it. We closed the book because we didn't need to look any
further – that’s life.
I moved on to general practice, because I refused to give ECT, and I had a patient come in, who said
the walls kept talking to him and giving him all this stick. I said oh, schizophrenic, and gave him
Stelazine, and off he went.
Eighteen months later he came back, and said he had a
terrible back pain. I asked him
about the voices, he said they’d gone.
Schizophrenia, an episodic disease. Opposite to what I had been taught. One of the reasons we have such inertia
in the psychiatric profession is because the psychiatrist works in hospital,
people who are ill go to hospital, people who are not ill, don’t go. So the psychiatrists don’t see them,
well.
Second thing I want to emphasise, I’m going to say some
very rude things about the DSM–IV (the Diagnostic and Statistical Manual
of Mental Disorders 4th Edition, 1994), which is the current psychiatric bible. Every psychiatric patient
has a code from this and it’s garbage.
In my book I say without a pill you can’t be ill. What we have got here is, ‘it’s your
pills doctor, that are making me worse. Your pills are giving me the disease which I came to you
for help.’
One of the questions I kept asking Bob W last night was,
where do we go? He has the
evidence, the evidence is out there, since the 1800’s and it is ignored. My privilege was that I worked in a
Therapeutic Community. I was
trained in a Therapeutic Community where social relations, social support was
considered the number one. We had
ward meetings in which the ward cleaner sat, and contributed. And that’s all faded away. That is the way to do it. Questions please?
Questions from the Audience. Thank you for your interesting talk. What I would ask you, is what do I
do? I help run internet
depression groups, where a lot of people are talking about the drugs they have
tried. How can I go about saying
that they really should be off them?
Bob W – it’s become a belief system. It’s part of our modern view point that
these things are forever biological.
It is interesting how patients respond to drugs, stories you read in
newspapers. I kept thinking
we are rational people, and if we can review the scientific evidence, we talk
about medicine, we can make changes. But we don’t.
What do you say?
I don’t know. My only
response is go look at the research literature, find out for yourself. But they’re not going to do
that. I think it is such a big
issue. I think it’s about philosophy,
what it means to a human being, what it means to be alive, and what it means to
be sane – an incredibly important issue. I know I’m not giving you any answers, I don’t have an
answer.
Audience. Should I say,
you should come off them with doctor’s help?
Bob W – There is no evidence of really good reports of people
staying on the drugs forever. It’s not there. Instead you find evidence of cognitive decline, early death,
physical problems, etc. Everything
shows that if you stay on these drugs, especially a cocktail of drugs, then you
see physical deficiencies crop up.
Many people wean themselves off successfully. Isn’t that a preferable life to be off the drugs, that’s the
message to give them?
And the other message to give them is look at the long term
effects. There are so many
problems in all these arenas – physical, cognitive, metabolic –
with long term drug use, that is what I would try to say. Try gradual withdrawal and if it
doesn’t work then go back.
Bob. When I spoke to Bob (W)
yesterday, and he said that in the States, you could be sued for not doing the
standard practice.
Audience. I have
friends who have weaned off, are terrified of telling the doctor, they are too
scared to say.
Bob W – one of the things we know, is the mind helps heal. Imagine being told that you are
suffering from psychosis, they don’t need even have the support of a doctor
offering the hope that they can get better. Now we know that hope is therapeutic, that’s
absolutely proven. Otherwise it’s so self-defeating. So (the doctor) basically tells you that you won’t get
better. Isn’t it better to say
there is no reason why you can’t get better and get on with your life. Hope is so powerful. Why not support
people through that process.
You have to lie to your doctor – that’s
horrific. Remember
when I mentioned the 3 trials in the 1970s? They worked in therapeutic communities. One of the programmes involved the
Soteria House. The head of NIMH
set up a Soteria house and people were randomised into hospitals or the Soteria
house. And the idea was the
support of being with people would help them get beyond through their
crisis. Even as a short term
remedy, that sort of therapeutic community worked.
Audience. We have to
go to the doctor. There is no
alternative.
Bob – Having been trained as a doctor, it is like
mental square-bashing, you have to be trained so if you cut the wrong arm off,
you go right back and cut the right arm off, so you’re trained like this. And doctors are trained to give
pills. And it is very
difficult to untrain them. The
pressure of the consumer, lets get some action with the consumer saying, we
want an alternative – this is perhaps the most optimistic opening.
[Editor’s note – the transcriber had problems with this presentation – for the full academic treatment with references, please see our website www.TruthTrustConsent.com]
Bob Those of you who recall my talks from
previous years, may remember some rather smudgy pictures of ‘Ethan’. I wanted to get a better copy of
these, so I asked the publishers of the book, “The Social Baby” in which they
appear. To my delight they
accepted my invitation to come and present their videos. The work, as you’ll hear, relates to
the very first minutes of life and if it doesn’t blow you away, something’s
wrong. Off you go!
Clive
I am Clive Dorman and this is Helen Dorman. We are directors of the
Children’s Project which we started following the birth of our daughter,
Hannah. We’re both visual people
with a background in publishing – we produced and published the “Social
Baby”. We spent the last ten years
doing our observations and studies.
If all else fails, it gives us many nice pictures for the photo album
which you can see here.
We went into this field for a variety of reasons, which is
mostly to do with the behaviour of our daughter when she was a newborn
baby. But we worked with an
open mind as we have always done.
I think the reasons why we are where we are now, is the result of our
observations and our own experience of parenthood with a sensitive baby. Most of our work, what we are here
today for, is to address other people’s perceptions of babies. I think a lot of what has been spoken
about now, is the result of what goes on right from the very start.
Our own daughter, Hannah, was very much wanted by Helen who
has been step mum to my two boys (now in their mid-twenties) since they were
seven and nine. Hannah is now
eleven and when she came along, after a long struggle, she cried continually
and we didn’t get any sleep. It
was about eighteen months before she slept all through the night, and had it
not been for the support of a dear friend of ours who worked in child
development and care, who gave us some pointers, I think our child could have
been very different than she is today.
A Research Health Visitor was involved during the filming
and production of the “Social Baby” and I said to her in the car on many
occasions – ‘Oh Hannah is so difficult.’ And she would say ‘if you say
that again I’m going to slap your wrist!
You haven’t got a difficult child, you have a sensitive child.’ And that one change of emphasis from
being difficult to being sensitive completely turned around our perception of
our own children. I think this is
a very key point which we will try and show today – all of what we do is
to show life through the eyes of a child and try and encourage empathy with
children as to where they are in the stage of their development.
Our strap line is ‘starting from day one to make a
difference’. Ten years
ago when we started, we needed to have a catchphrase, you can’t do anything
without a catchphrase.
When we started we thought it meant from birth, but it actually means
from conception. It happens
during that time when the baby is developing inside its mother. This is the key time. What happens to babies in the nine
months, between conception and birth moulds their attitudes, expectations about
themselves, their personality and ambitions.
A foetus can see, hear, can taste, can remember and learn
from repeated experience and that is very important. The mental well-being or otherwise, of the mother is passed
on to the developing baby and lays the foundations for future emotional
life. The foetus has feelings,
emotions and a perception of the world into which it will be born. And from a book we have been reading,
it says that the womb is the baby’s first world, the womb establishes the
baby’s expectations that the outside world will be the same.
Despite all the publicity, a lot of what is being spoken
about today, and will continue to be spoken about, applies to us in our work
which we are trying to achieve – many people still underestimate the
abilities of the newborn baby and indeed its abilities before birth. There is an extraordinary story. There is a still photograph of
this. A hospital in the US does
pioneering surgery to help pre-term babies diagnosed with spina bifida. The procedure involves the equivalent
of a Caesarean section, cutting the mother to access the baby, making a small
incision to carry out corrective surgery on the developing baby. And this picture shows the
baby at 21 weeks during the operation; and its quite graphic, but very well
worth seeing. What’s happened here
is – they’ve finished the surgery, the ball you can see is the womb, the
hand is the surgeon’s hand, as he was about to close up the incision, the
baby’s hand comes out and takes hold of his finger. And the story goes that he tried to remove his
finger, the baby squeezed, and held on. And this is at 21 weeks.
It is all very well saying about baby’s abilities but what
really makes the impression is seeing these things with our own eyes. And we are probably better known
for producing a book –“The
Social Baby” which is now widely used and recognised around the world. It is now available
on video and DVD. We were
fortunate to work in partnership with the NSPCC and used as original footage
from the book. When we produced
the book, we did the video filming with the families, and then we ran it
through the computer and took out picture stories, frame by frame. We will show a few minutes of video, a
technical challenge!
This is one of the ‘wow’ factors which makes the book very special. It shows what happens to Ethan
immediately after delivery. It is
self-explanatory.
[ Musical interlude. Sound of a baby crying. The video is being shown. ]
“As soon as Ethan is in mum’s arms he begins to
settle. Within 10 seconds,
he is calm and quiet. A few
moments later, mum offers Ethan her breast, but Ethan is much more interested
in looking at mum’s face. She
talks to him, he clearly responds.
When his dad speaks, Ethan turns to him. And when mum replies, Ethan looks back up at her. Ethan already knows these voices and he
knows they are important to him. A
little later Ethan really shows us what he can do when he is put into his dad’s
arms. When John sticks his tongue
out, Ethan looks hard and concentrates.
And then sticks out his own tongue. Ethan does the same thing again, a moment or so
later. While Ethan is still in his
Dad’s arms, his mum speaks. Ethan
immediately looks round, and keeps looking at his mum, so just a few minutes
into his life, Ethan is already interacting very deliberately with the world
and the people around him.
“[Ethan’s mum] For me, it was just lovely, to have that bond with Ethan
when he was first born. And to see
that he actually recognised who I was, and that I was his mum. His movements and reactions so soon
after being born. You would
not think that a baby that new wouldn’t necessarily be in as much control as he
was.
“[Narrator of video] We can
also see that Ethan has a real preference for faces. In this experiment he was shown two paddles, one which
looked like a face and one which didn’t.
Ethan knew absolutely which one he preferred. ” [end of
video]
[Clive] Ethan was
born 8 minutes past the hour and all that happened within 45 minutes of him
being delivered. I hope you
enjoyed it!
We are in the process of filming a range of births and we
have a second birth where the mum and dad have a similar experience. I think the important thing here is
that both of these deliveries had been without drug intervention. I think Julie had gas and
air and there was nothing else offered.
So the baby was born quite alert, because it hadn’t been affected by
drugs administered.
[video is being shown]
[Sound of cooing at a baby!] “Hello!”
[Clive] Coming up,
his mother’s going to make some sounds, and you have to see how he changes from
being focused on his father.
He’s actually becoming quite disorientated.
This is just in slow motion because what is happening is
extraordinary. [video is being
shown]
All you ladies that have children know what’s going
on! [More childbirth noises. Delivery of afterbirth]
[Clive] I defy anyone
to say that newborn babies can’t see.
Or that they can’t show pleasure. [end of video]
Here is a set of four pictures, we ran them through the
computer and we then had the benefit of seeing 25 frames per second, so we get
to see very minute detail that you might not otherwise pick up if you are
looking at a film. These are in
the sequence of four little pictures.
Having been at three births myself of my own children, I felt
like a complete spare part and I actually felt very undervalued which, even
though I was told that I wasn’t, I still didn’t believe it. But these sequences were filmed when
the mother is delivering the placenta.
And it is a lovely time for the dad just to have a really close and
intimate moment together, and build a bond between the two, which is very
important.
I just think those pictures are very cute.
On a slightly different project we did some work in Watford
with Liz Andrews who is the co-author of “The Social Baby”. We were trying to get some more
interaction between a mother and baby. And again we didn't notice this at the time, but here
is what we call a three second clip. Watch it closely. It is quite extraordinary. And it just shows how actively little babies want to
engage in their world around them.
[More video footage being shown.]
It is so clear that he is responding to his mother, he’s
actually turning with her, and he is very connected with her which is really
nice. One of the things that
happens is – we tend to riddle people with guilt. You think, oh I’m not looking at
my child at every moment of the day. And you can’t possibly do that of course, but we all
do the best we can in raising our children and moving things forward a
bit. But what happens
if, when that best we can isn’t working. Bob’s work, and others shows that we have the ability
to be learn to be different which gives us all hope. So if actually you have had a disastrous time, and think
it’s the end of the world, and things won’t change – there is hope.
We are only showing one part of the story. It might be a bit shaky.
[More video. A
young toddler being told to sit down, continually. Told off, stop it!
Don’t do that! Stop kicking
about. Sit down. Don’t do that, stop it! Stop it! Pack it in!
Don’t do that! I’ll tell
Daddy. No, don’t do that. Do
you want a smacked bum? Eat your
sandwich. Come on. No, eat the bread as well. Please!]
This is quite a familiar scenario with many people. The point is that Sarah’s having
problems with every aspect her life with Jake. It isn’t confined to lunchtimes. It was whatever they tried to do
together. She loved her
little boy, but she always seemed to be in conflict with him. Later she told us that things got so
bad within the family that she and her partner split up for a number of
weeks. Jake had been flagged up as
a difficult child at nursery.
And she also said she was on the point of taking him to the doctor to
see if she could get him put on Ritalin.
This boy was only two, around two. What we observed in the filming we did
with her, was that the conflict wasn’t the result of any conduct disorder, or
of Sarah being a terrible mother. Sarah she was putting herself under a lot of
pressure to make Jake behave in the way she thought society expected. But instead many of her expectations of
Jake were unrealistic and beyond his comprehension. His brain wasn’t sufficiently developed to take on board the
information she was giving him.
So next we invited Sarah to get involved in a role play
session to try and help her move on and we have got some footage coming up
now. [video played]
[child’s voice] “To call us stupid, or an idiot is very hurtful and
undermining . . .”
[End of video.]
[Clive] Sarah
said she went home and burst into tears after that last session. I think it made her think how she
interacts with her child. We
went back to her house and repeated the lunchtime session. This time we had a conversation before,
though obviously these are only snippets here. Helen gives her bits of guidance as she goes through
lunch.
[More video footage.]
We edited it down for presentation but we need to go on to the
lunch. It starts here…
[Video footage.]
“Would you like some chips?
Yes?
Yes, right like some chips?
Is that nice?
Good boy! Now, don’t do
that. Move up a bit so you don’t
fall off. Here you go. That better ? Is that nice? Pause…
Hmmm, ma ma ma!
[Suggesting that the mother and child are sat at the table
and dealing with the situation.]
Do you like carrots?
Ohhh! Are you
making a mess? What do you want to
do later? Do you want to go and
see Nanny? Go out to see Nanny in
the car?
In the car?
Yes go round to Nanny’s in the car!
“Yes. Nan ‘n
the car”. Yes.
Hmmm…mummy got pickle. Lovely, hmmm.
. . . .
..tell him no, now…Now!
[Child screeches and makes noises. Helen suggests ignoring
and then distraction]
Look at the ladybird and the bumblebee!
[Child cheerful]
[End of video.]
We’ve edited it down a bit. These were early days with Sarah, and even she couldn’t
believe the changes in his behaviour.
She said “I realised it wasn’t Jake that had changed, it was me. It was hard work but the rewards were
fantastic.” In total we
actually spent about eight hours with her, which is a lot more than we needed
to film. We probably had about six
hours which have totally transformed her life. I know there are extreme cases, but a great number of people
just need a few details and a little bit of tweaking, which can very easily
bring behaviour back to what you hope it is going to be.
That brings us to the end of our presentation. But before we do, let’s all stop
a minute and think back over the last couple of years. All the major or significant things you
have experienced or achieved, only briefly. Think about anything, but nothing ordinary or routine
– and the first thing today to bear in mind today is – socially and
emotionally. Next, mentally and
finally, physically. What we have been discussing here is what has happened in
about the first 2 years. So look
at the changes from when the baby’s in the womb to the last clip we have been
looking at, it has been an enormous amount of achievement which is way beyond
anything we will have achieved in the next two years or the last two
years.
We put it into the context of social, emotional and
physical development and babies from birth becoming a problem. Think about what is going on in
the brain…
So in our final statement, ‘when we show our children that
we can listen to them, respect them and empathise with them, they will learn to
listen, respect and empathise with those around them and the world in which we
live.
Thank you very much.
[Applause]
Bob
Fantastic.
There are two comments I want to make before we go on to questions. Firstly with ultrasound, giving the 3-D
pictures of the foetus, you can see very clearly that the foetus is
smiling. I remember when I was a
general practitioner; we used to have one of the milestones – at six
weeks old the baby starts to smile.
The baby has been quite capable of smiling long before. So something’s been going wrong. The second thing I want you to recall
and keep this in mind till this afternoon, is the clip there where you played
it the second time in slow motion, with the little baby being held and then you
said ‘watch the changes in the child’s face’.
I’ve just been reading a very thick and verbose book, and
that’s where the first two words in my title for this afternoon comes from -
dyadic-intimacy. All
that means is an intimate relationship between two. And there you have the infant with an almost tangible
intimacy with the mother.
And the book I’ve been reading studied a lot about the brain changes,
changes that come in the frontal lobe in the wave patterns of the mother and
related to the wave patterns of the child, the infant. But that is such a graphic illustration
of the bond that starts at that age.
We’ve time now for questions and we’ll break for ten
minutes.
Audience : Just a small piece of information that absolutely you could
feel, I work in education, the teachers, I had a student the other day who was
an expert signer. And she
told me that babies could communicate using sign language from the age of eight
months that is ten months before they start to use spoken words.
Audience : What about the father? Especially one that works at home?
[Clive] I don’t think
gender is the issue, it’s the interaction that is important.
Audience : I am thinking about children who are born that don’t have
contact with mother. For instance babies in special care units how does that
effect their development? My baby
was born ten weeks early, and always had problems at school. And I met another parent, a
mother whose child was also ten weeks early and the behaviour was the
same.
[Clive] It is difficult with premature babies with
interaction. I know that they now
are much more aware, and they try and help with this group.
Bob
Many many thanks for your interesting talk.
Before we proceed, David Kennard has a few words to say.
[David Kennard] Thank you Bob.
I am just going to mention an organisation which I represent called ISPS,
which stands for the International Society for the Psychological Treatment for
Schizophrenia. They are very much in tune with sorts of things Bob Whitaker was
saying. This organisation is all
about trying to promote the use of psychological approaches of all kinds,
psychotherapy, art therapies, behaviour therapies, all the things that can help
people with psychosis in addition to drugs. As Bob [W] was saying, not as an exclusive alternative to
drugs.
This organisation includes professionals and service users
and their carers as its members.
There are networks of this kind in about 30 countries including the USA
and there is a growing network of about 400 or so members in this country and
we put on conferences, we have a newsletter, have a very active email list, a
discussion group for those who have the Internet and we have also developed
local groups in different areas.
We have a stall in the display area and very much welcome
anybody who wants to come and find out more about ISPS in the lunch break. Thanks.
[Bob]
This section is a regular section that we have and we are
very appreciative of people who are prepared to come up and address a motley
crew like you. But seriously, we
are asking them to show a lot of courage and confidence. Before we do that I want to show you
some video tapes of people who can’t come. The first one is a man that I met at Parkhurst and who
I video taped on 11 September 1991.
I’ve shown this video tape almost every time I speak. And I’ve checked, and the dialogue is
transcribed in the first of these collected conference proceedings in
1999. The reason I quote him is
because it does show how a mind can’t function clearly. And also it shows the
crucial importance of attachment, or in this case discipline by being
smacked. That is in the first
section where actually Lenny knows what we are talking by the time I have the
confidence to ask him if I could tape him. We sit his mother in the corner and ask him to say something
to her.
Lenny is convicted of murder, a life sentence prisoner and
what he says to his mother is quite astonishing. He says, “Hello, mother. I am an adult.”
And this is a crucial demonstration of the difficulty the human mind has
coping with emotions, high emotions, and in particular fear. Before I show it, I want to say, to my
great delight, I managed to contact Lenny through a series of happenchances and
serenditpities. One of the real
difficulties in my life is in following up against the standard prison policy
of omerta. That is to say, you are
not allowed to talk to or contact people that I treated. I treated 50 people in Parkhurst
special unit and we were friends.
Repeated letters from me are returned from the Home Office or sent off
to the Department for Outer Siberia.
However, through a series of incredible happenchances, I managed to
locate Lenny and I went to see him on Wednesday, last. He is in excellent spirits. I don’t want to say too much in case
what I say about him prejudices his chances. Just think about that possibility. Here he is in 1991 and he is explaining what I do and why.
[video runs]
Lenny needs to tell his mother he is an adult which happens
to be the truth.
Bob
He is saying there that he has found the resilience of the
human spirit. Here he says ‘you
can’t hit me any more’. I didn’t
say that. But he said that. And basically, a victim of trauma which
can cover the whole psychiatric spectrum, cannot overcome that, unaided. They take the traumatic event with
them. They need support in order
to undo it. So here is Lenny eight
weeks later. . .
[Video tape resumes.]
Bob
‘You are brainwashed into fear’ – and that is basically
all that I do in my work. I give
them sufficient support, non-parental support, to look at the brainwashing
– they unpack it. The next
two clips are from Karl. Now some
of you will remember a very dramatic occasion, three years ago now, when the
governor of a medium security prison in Edinburgh provided a prison officer to
accompany Karl to come down and describe what his experiences were.
He was eventually released to a probation hostel last year;
and the probation service would not allow him to attend this conference. Conditions of lower security prevented
him still. This year,
unfortunately he is suffering quite severe medical problems, kidneys and so on
and is too unwell to come. So in
tribute to him, I want to show you the video we took of his first attendance
year. This demonstrates so clearly
where violence comes from and what we need to do to unpack the violence. One of the things which occasionally
gets me a little bit pessimistic is that there is clear evidence of change
being possible with the most damaged and dangerous individuals. And here is Karl very articulately
describing what the problem was from the inside. If I fret about too many pills being prescribed, I also fret
about too little talk. Here comes
Karl.
[Video starts.]
Bob
I just want to mention that I cut it off, because it is a
big subject and it wasn’t possible to go through it in much detail. But what he mentions there is the
PCL(R), which is the Hare Psychopathy Checklist and this is used in a
bludgeoning, irresponsible way by the established psychologists and
psychiatrists. And it
purports to say whether this person is a continuing risk. And of course it does nothing of
the sort. So if you want to get
pessimistic about the psychiatric drugs, you can also get pessimistic about the
tests which rules the management in so many cases of people being particularly
dangerous in the past. And
on a personal note, the discrepancy between Alice in Wonderland and the reality
of the people who are being dispensed this artificial tests has led me to draw
a line and decide that when I participate in the tribunals system, in fact I am
doing a disservice to people. My
going along suggests things will change whereas in fact, my experience is to
the contrary.
I will now show you some clips of Tony. Tony I met in Hull and I am absolutely delighted to say that
his present prison governor responded positively to my request to release him
for today and there he is at the back and I am going to embarrass him a bit
with some video I took two years ago. And then I am going to ask him to explain
himself. So I will show you the
video of Tony and then
I will ask him to come up.
Just before showing Tony, here is a clip from Dawn on the Isle of Wight. She set up a panic attack support
group, and did a ‘go-round’.
And all these people described their panic attacks. And she said, ‘I know why you’re panic
attacks. Shall I tell you?’. So she tells them. And they got better. So she closed the group. Here she is describing what it’s like.
[video plays]
Now here is Tony. What I want
to say is that we have been discussing a lot about attachment in early infancy
and how crucial it is. But
parents have two obligations. One:
bring up the child, two: bring up the child to be independent. The other thing that Tony demonstrates quite clearly is the
notion of resilience, that we were talking about before. So what do you think of the video Tony?
[Tony]
A lot different to what I am now.
Bob
What are you like now?
[Tony]
I have freedom.
I got freedom to do what I want, be what I want.
Bob
What was the trouble before?
[Tony]
The trouble before was I was looking for a mother all my
life, my teenage life, adult life and you made me realise that I didn’t need
one. That all my problems were like
release from knowing that I didn’t need a mother.
Bob
You didn’t know you didn’t need one?
[Tony]
No, no one told me before.
Bob
The key to my work was the realisation, that infants have a
different relationship to the world, one that you have seen very clearly this
morning, than adults. Parenting
keeps, as I say, keeps infants alive, without parenting infants die. Parenting misapplied, keeps adults
insane. You’d go along
with that ?
[Tony]
Yes.
What happened, when I saw you. . . Like the drugs before, I had been
diagnosed with manic depression and everything else that goes with the side
effects. And I ended up on a
cocktail of tablets. I just
thought to myself, I am not changing, I am just getting worse. And I did get worse and then I after
saw you (Bob), I
thought I don’t need any tablets; I never had any tablets for the last
three-four years. I just don’t
need them, they don’t do anything.
Bob
How many of your prison friends do you think this applies
to?
[Tony]
Thousands. I think,
everybody that’s in prison – they’ve got a root problem. And I think the prison service
are only there to look after them.
Probation officers and psychiatrists only skate over the top of the
problem. It’s only people like
yourself that to get to the real root of the problem, and get rid of it.
Bob
What is the real root of the problem?
[Tony]
The real root of the problem is stemming from your
childhood. And as you are
getting older, you are learning to live with it, learn to control it a
bit. But you can’t, because
it just keeps coming back.
People just hide it. You
hide it yourself, you lock it away and you need to get it out of you and you
need someone like you to bring it out of you.
Bob
You can’t do it for yourself?
[Tony]
You can’t. It
is impossible.
Bob
I mean the parallel there with what Karl described as being
unable to address the problem himself.
It is exactly the same. If
you see the problem you can see solutions for it. If you can’t see the problem, you can’t see any solutions.
[Tony]
No, you are blind to it. Because you can’t see the problem. It doesn’t matter how many probation officers you have, or
how many times you go in prison, or how many drugs you take. You still can’t
cope with the problem because you can’t see it. You are blind to it.
So really you are just living a non-existent life.
Bob
What would you say to people who say well you’re mother is
always going to be special to you?
What would you say about that?
[Tony]
I would say that in some ways, as far as a mother goes, a
mother is always special to you.
But what is more special is your own life and you own dependency and
your freedom, that is what’s special, not your mother.
Bob
When I came to see you, the model that I have is that you
were still focusing on solutions to your childhood problems – which was a
good mother. You were put up for
adoption when you were six weeks old, something like that, and your real mother
came into the picture again when you were 12 years old. Lots of problems in the interim. But the model that I work on
that, as an infant, as we saw, your life support system is in the adults around
you. The parents around you. And as an adult, your life
support system is on a mutual, equal basis. Would you agree with that?
[Tony]
Yeah. When you
become an adult and you have been looking for motherly love, the care of a
mother, you try generate all those feelings in people like probation officers. And you start looking to them for
love. And you start using
prison as your home and your protection and looking for people to help you. Where you haven’t got a mother, so you
expect them to a motherly figure to you and obviously they can’t be. So you just never get rid of any of
your problems. Until you get rid
of knowing that you don’t need a mother, you don’t need looking after, you’ve
grown up, you are an adult, then it doesn’t go away. But once you have learned that you are an adult and you don’t
need anyone to look after you, you can look after yourself. That is when your life starts
changing. Like mine did.
Bob
Was it a shock to you when I said that?
[Tony]
Yeah, a big shock.
Bob
What was it like?
[Tony]
It was a big shock in the respect that I expected you to
diagnose me as just being depressed and send me away with another set of
tablets. But when you said
that I didn’t need a mother, what I used it as, was I don’t need probation. I don’t need to try to look for a
mother. I don’t need institutions,
I don’t need prisons, for a home.
I can grow up and be like everybody else. And look after myself and not depend on other people to give
me my own freedom.
Bob
Fantastic!
Thanks a lot Tony
[Applause]. It brings
tears to your eyes. The thing is
you can see you have a human being there; he is so articulate, so appreciative
and he is so changed. And this
is so depressing going around the prisons and you see people like Karl at one
extreme end of violence to Tony – and they all need to throw out the after effects of traumas,
terrors that have happened to them when they were too small to know anything about
it.
I’ve asked Claire to come on the platform now, and again I
must say thank you to her for having the confidence to do that. I don’t know if you want to say
anything particular. Can I just
put in the context from last week?
Last week I asked Claire to come with me to a conference
organised by the Borderline Personality Disorder World, BPD World. I made a rule, some ten years ago, when
I met some psychiatric hostility, never to go without a video. But I am changing that now to:
never go without a video and a living person. Well, here she is.
Claire
It was a conference I think for medics and nurses and workers
in BPD and it is organised by BPD network.
Bob
What did you learn when you were there?
Claire
Well, I think when I listened to all the different speakers
and all the different people saying all the different kinds of things. I have had quite a few different
diagnoses and mainly the DID (Dissociative Identity Disorder), and Personality
Disorder and PTSD. Listening to
all the different accounts of all the different things, I just thought well,
what is this all about? We have
talked a lot about it. It is all
part of a spectrum. And
there is really not that much difference and I think I learned – what
does it matter anyway? Go back to
what I have done to change really and not to get hung up on the
differences. I learnt that you can
struggle getting over your own views of your struggle to get well, then you
have to struggle against the DSM.
Bob
What I should have said earlier is that Claire suffered
from many years of abuse as a child. And when she first came to see me, she
suffered quite severe self harm, multiple personalities and a whole series of
symptoms. They all related down to
one major emotion didn’t they?
Claire
Yes, fear, which is what I am feeling at the moment! Yes, when I was listening to Tony and the other things that you said
that self harm is violence and you don’t want to admit that you are angry. And I think I remember saying I
am not an angry person, I am not angry.
And that’s the first thing that Bob focused on in the first session, I
think within the first ten minutes of seeing him, he said ‘what you are angry
at?’. And I think that’s the
thing you don’t want to admit – that self harm is anger and violence,
from fear.
Bob
So how would you say that you’ve overcome this terror that
you did have and was driving you to all these different symptoms?
Claire
In our work, we started about four years ago. We had eight months quite intensely and
I think what I learnt is the things that you have been talking about; sorry
I’ve got a bit lost.
Bob
That’s all right.
What you are trying to say is that when you came to see me, I was
looking for, as you say, anger, but also fear. It was the fear I want you to talk about.
Claire
Fear of my abuser, is the main thing that I have
learnt. These things have set me
free from it. I was scared and
terrified of my grandfather and he abused me for a long time and it was very
sadistic. I wasn’t even aware of
that stuff until I started looking at it, because I was too frightened to face
it and too frightened to face that it was my grandfather and too frightened to
face it at all.
And I think that is why I split it into different
personalities and tell you what to call it. Going back to being two. And I know you kept saying that’s two year
old. And every time I was
frightened or every time that I felt like self-harming, or felt angry, whatever
emotion it was, it was going back to me being a helpless two year old.
And I was forty-five when I met you (Bob) and I still felt
like a helpless two year old. And
I still was being a helpless two year old. I was immobilised by it and recently more than anything, I
found it difficult even to put my grandfather in the chair and face him, it’s
almost like he’s still there, even though he has been dead for twenty odd
years. That fear, facing the fear,
it is almost like - - if I was frightened of him then I couldn’t be
myself. And it wasn’t until
I could face him saying ‘if you were here now, I wouldn’t be frightened of you
because I am an adult’. Just
feeling like an adult, like Tony was saying, in my head, I tell
myself I am an adult. Yet I felt
like a child.
Bob
The really striking thing about the impact of trauma, Bob
Whitaker was saying yesterday, the psychiatrist won’t discuss trauma. I don’t know how they can be psychiatrists unless they can
discuss trauma. The model that I
use, is that two year old’s feelings – the feelings you were suffering
yesterday or today – were in fact those of a two year old and you were in
fact reacting as if you were two.
Claire
Yeah, when you said about different personalities, that
they don’t exist. You were one
person and you feel that you’ve fragmented all into different bits. Every time that happened you would say,
okay who are you scared of? Whatever. We never got into that did
we? We never got into talking to
personalities, it didn’t matter anymore.
It was actually looking at fear and just keeping or facing it, also of
being allowed to be frightened.
Like Karl from the video.
Bob
What I set out to do, first of all was saying that being
multiple personalities is not acceptable to me – and I won’t do
that. The main thing I needed to
do and needs to be done in cases of severe abuse such as yours which was severe
is to say, well the terror is there, and I’m supporting you looking at the
terror. The key word being
support. With enough support you
could then see that the terror was driving these very exotic symptoms. The more imagination and
creativity that human beings have steadily produce a whole slew of
symptoms. The DSM said
oh these symptoms are important.
Symptoms aren’t important.
What matters is the severity of the symptoms and that indicates the
degrees of terror that’s driving them.
Claire
Describing all these personalities led straightaway to ‘oh
you have a split personality’. And then it becomes ‘you have a personality
disorder’. None of this
matters. I think that I remember
meeting you, telling you stories of this happens, that happens. Well if I think, it is flim flam, it doesn’t matter. It is what you are frightened of, what
you are frightened of now. You
being an adult, taking responsibility for yourself, I think that made me think.
Bob
That is exactly what I said is that you have had to take
responsibility yourself. But
just let me emphasise, what you are saying is that the terror is there, I am
looking for the terror, by the severity of your symptoms. The difficulty is that you are fighting
revelations of the terror, you fighting acknowledgment of the terror. You are saying, well, if I criticise
granddad, he will kill me. That is
automatic. There is no way I can
look at the terror. Would
you say something about that, because that was what it was like to begin with.
Claire
I think even until recently it was like that. I remember when we do something about
me looking as a two year old; it is like I am still looking at that two year
old. That was me, I was scared, I
was absolutely terrified and if I say anything about my granddad even now, I
would be dead. It was
ingrained.
Bob
It is just automatic shut down. This is why I showed you Karl because he says in the
description of the therapists and asks them why isn’t this working. And he said I can’t stop my mind
turning off – which is exactly the problem.
Claire
You don’t feel. It is some thing that people switch
off. It is a spectrum
really.
Bob
Just turning it off is much safer, not to feel anything,
than to feel anything real, reminding you of your abuse. That is the way it goes. Brilliant! I want to say again, thank you for coming up.
I am having a wonderful day. This gives me an opportunity to ask people, both on videos
and on coming up to the platform to describe in real emotional terms what we
are actually talking about. The
title for today is “Better Ways To Mental Health” and there are better ways for mental
health. And the proof of the
pudding, is as you have seen this afternoon. Great. Thank
you.
Now it is just coming up to half past one, we start again
at 2.30 with something really interesting. So see you all then and have a nice lunch.
[Break for lunch]
Bob
Tony, who you saw before lunch, is on a tight schedule with the
prison service which I can well respect.
I was very concerned to give you an opportunity to ask some questions so
if we can ask you to come here and ask a question to put to him, since he won’t
be available on the panel later. Tony where are you? (Discussion about the microphones)
Right, we have cobbled the programme for you to have an
opportunity for you to ask Tony some questions and if you don’t ask him, I will. Any questions that anyone would like to
put to Tony? I am standing by with the mike! Here’s one.
[Question from the audience] I wonder if Tony what thinks – we have learnt so much from talking to
Bob about your own experiences.
Are you able to be more helpful to other people?
[Tony]
Yes, definitely.
At this stage of my life, I am glad that I am glad that I
am able to feel better and I am glad that I am through my past and what I have
been through, that I am able to help other people in my situation.
Bob
When he came out, it was difficult to hold him down, he
wanted to speak to all his prison friends, he wanted to send the video all over
the place. So it was
wonderful. Putting his past on
video and that is still going isn’t it?
It is just so incredible. And there is one thing I would like to say. One of the reasons that I devote
more time to the videos, to organising the videos, that I have got, is to try
and piece it out into a story that you can show to people, as you saw with the
video of the mother and child there.
These things get straight through, you don’t have to speak a language,
you can see the emotion and you can actually work through and hopefully be more
encouraged.
Question: Somebody that works in assigning people with very similar
problems to yourself, post traumatic stress disorder and I would like to know
what you found were the most important things that made you feel really safe
enough to making a video? What
made you feel safe enough to be able to go down the route of the revelation
here?
[Tony]
I tried to hide it for many years, I tried not to go down
that route, I tried drink, drugs, everything under the sun, rebelled against
everything. Unfortunately it was
the things that happened to me in my life as a consequence of doing that, in
the end I just had to say, I have to get to that route, because there is no
other way.
Bob
I think that what struck me was and one of the reasons is
that when Tony was in
prison, he thought he wanted to speak to somebody whilst in that prison and he
spoke to someone called a ‘Listener’.
And he said ‘you are pressing the self-destruct button’. And this was a novelty. So that when I came to see him, the
solicitor who asked me, who is close to my work and he trusted me. So I came in to the situation with good
representations you could say and for me, in a sense to try and open some of
these boxes. I have to say that
when I said to Tony,
‘can you tell me your story,’ and he gives me 30 minutes of dreadful events
that have happened. And
after that I said ‘now it is my turn’. And I asked him ‘do you need a mother? And as he said just now, no one
had ever asked him that.
There are several reasons for that. One is that you will need know thst
people in his position often fend off that question and don’t allow themselves
to hear it. But at that
stage of the interview which is probably about 40 minutes into it, I felt I
could broach this very difficult subject. And his response was very, very defined. So why did you as to speak to the
Listener?
[Tony]
Uh, can I just say like people in authority like, you’re
sat on one side of the desk and they are on the other side. It is hard to open up your feelings,
it’s easier to talk about things you have done wrong, lifestyle things. Probation officers or the people
like that aren’t qualified to help people like me because all it needs
sometimes is just someone to listen to you. And not say anything. And just to make you feel like you are loved and that
you really do care and you find out a lot more about the person doing that than
you do like sitting on the other side of the desk, demanding you do this and
that and the other. All it needs
is a little love to find out how that person really feels. So the answer is simple, it’s so
easy, like Bob, ‘you didn’t need a mother,’ that was the answer to all my
problems. It was that simple but
some people think it is so difficult – that there is no answer.
Bob
But I emphasise again that if you hadn’t had that half hour
to begin with to trust me.
The way I described something terrible happens in childhood, you put the
lid on the box. That is your lid,
your box; you decide if you want to open it or not. And you are not going to open it if there is any threat, or
pressure or authoritarianism or you are a naughty boy, I am going to tell
you. Or, here’s some more pills. Or whatever it is going to be. But as you say, the first half
hour, I mean, I just sort of do it.
And that is what you need to do. But once you have done that, then it is just human
beings discussing. Would you agree
with that?
[Tony]
Yes, of course.
When somebody asks you to bring the root of your problem out and you
have had it for so long, you build up this such a scared image of what is going
to happen when they get down to that root, that you don’t want to face it. When Bob made me realise that nothing
is going to happen to me if I come to the root of my problem. Nothing can happen already worse than
already has. Can life get any
worse? So when he said get to the
root and you’ll be fine, I trusted him.
I believed him. Because he
didn’t try to say get to your root and we’ll put you on Prozac or get to your
root and we’ll put you on your “Jack Jones” for ten months. He just said, ‘get to your root, you’ll
be cured,’ and I was.
[Bob]
It is so difficult to get to a position of confidence. Now I want to know what happened to you
as a child which is holding you up.
‘Oh nothing…’ What is it?
Not going to tell you!
Until they say the last bit, you are talking to a brick wall. And when you said you kept defending it
and denying it, that is the lid on the box and it takes a lot of undoing. ‘Well, I just want my box’. However I jump up and down and say the
box is empty and ask them to believe me – and that’s all.
They say they are going to open the box because they trust
me enough, which is what Tony did.
But when I said to him about wanting his mother or some such phrase and
I stood back and I thought well the door is there: I can always leave. When I was in Parkhurst Prison three
murderers threatened to kill me, because I appeared to threatened their mother,
or I had criticised their mother or father, I can’t remember. But what I was doing was what Tony was saying before – I was
shaking their foundations before they were ready, before they had given their
consent. And that can be
very dangerous.
In Tony’s case you can see. But
only if you grasp the opportunity, I mean, I just put it on the table – I
said some people of your age don’t need a mum. All that yearning for a mother as you described it. And his criminal activity could
be seen in that context like – the world owes me a living, and they don’t
give me a living so I take the living. And then they don’t like that so they
lock you up. In this case he
had been preparing since the Listener.
He has been thinking about things, rather than saying the world is
against me. Saying maybe there is
something inside I need to look at.
And I was able to say, well look at this bit, forget all the rest, just
look at this bit and he was able to grasp it. And you haven’t looked back have you?
[Tony]
No.
[Bob]
Time for one more.
Question:
Considering your relations with the probation officer and
dealings with prison doctors and psychiatrists, I wonder if you would contrast
how you got on with them with how you got on with Bob? [laughter]
[Tony]
Um, from growing up and seeing probation officers –
there is always a barrier. The
screen goes up as soon as I walk in the room. With Bob, I didn’t know Bob, I didn’t know what he work was
about. I knew he was a
psychiatrist. I was expecting to
be diagnosed anything. And
to be given any kind of medicine, which I would have accepted. I would have took. But when Bob came into the room,
Bob told me that I had to get to the root of the problem. Where probation officers tell you where
to get to the root of the problem.
It is probation telling you to can get to the root of the problem and
you don’t even know how yourself.
So nothing gets solved. Bob
brought it out in me to bring out the problem. Bob didn’t get to the root, I got to the root. Bob allowed me to do that – where
probation officers don’t.
[Bob]
It’s called persuasion! Any way I have to draw the line there because we are running
out of time. I promised him
out by a quarter to. And he
is very concerned that he fit in with prison regulations, as you can see. I would hesitate to breach
them, because the governor is very good in my view to allow him to come. Anyway thank you very much!
[Applause].
[Bob]
Follow that, as they say. Right, I shall be brief. I am having a wonderful day, I
think it is fantastic! What is
fantastic really, is that you’ve got human beings, being human beings and human
beings responding to human beings. Well that is really what I am talking
about. I’m talking about ‘dyadic
intimacy’, which is a fancy Greek phrase. Watching that video tape of mother and child or father
and child, you can see reciprocity, in reciprocal relationship behaviour
– in that when he mother looks away the child looks away, the father
looks away the child looks away.
There is a harmony, a very profound and vitally important link between
infant and parent. That is the
intimacy bit, and the dyadic bit is that there are two parties involved. And the challenge is how do you
transfer what it is clearly a joyous and such a creator of fruitful
relationship in the mother-child, father-child, how do you transfer that into
adult life?
There is not much talked about adults’ intimacy in that
sense. It’s not established as a
norm, it’s not established as something which should be expected. And it is something which is very
practical, you can see the attachment between mother and child there, from the
video. You don’t have to have
someone saying look and these two are relating in a positively creative way. You can see it for yourselves. And what we are hearing this
morning, is it’s by consent on each part.
If the mother says you don’t do it that way – no, no, no. The mother isn’t consenting for
the child to be that way and the child isn’t consenting for the mother or
father to be like that. So consent
is a crucial thing.
But what interests me is, what about transferring that to
dyadic intimacy between adults. Dyadic you can throw away, and you can have
plural intimacy between adults.
What is it? Human beings
are remarkable creatures but they don’t, in an important sense exist, except
socially. They exist by
relating. They exist in
relationships. And the
critical thing that I am taking from my work is what we have just been hearing
about which is a life support system which depends on parental power, in fact
the infant has to manipulate the parent. If the parenting is deficient and it’s a poor
attachment, then the infant has to manipulate the parent. And as Tony’s case, up to the age of 42, he
was still looking around for a
mum, or for a substitute mum, or a good mum or somebody to look after him. By a process in which I was the final
key stone, he is now looking after himself. This doesn’t mean he doesn’t talk to people – he
really does. He makes friends, he
makes mutual relationships mutual.
But he is no longer dependent on a, in his case a non-existent or
defective parent and of course that is always the difficulty. If you have a solid infant attachment,
then as the child grows up and the parents fulfil their second obligation, then
they get independence. The parents
encouraging independence. And the child grows up to an adult and can float away
to become a solid individual who is then relating to his or her parents on an
equal footing.
If you get an insecure attachment, then the infant is still
looking all the time for a secure attachment. For the infant knows from before birth, that survival
depends on a secure attachment.
Every human infant is born quadriplegic, they cant move any of their
limbs, usefully. They know this
and they develop a survival strategy which says where’s mum or where’s
dad? The difficulty is all I do in
my work which is to say that you have to transfer your life-support systems
from a parental figment, onto your own resources. And it is not easy to get across. And the reason that I like to
show and talk about Tony
is that he demonstrates this so very clearly.
I always like to include this slide, it’s from the Sunday
Times, June 2003. And the
caption says birth defects – since addiction was found to be an inherited
disease, scientists sought an effective cure. How close are we to eradicating society’s most difficult
illnesses? Well that kind of rhubarb makes it much more
difficult. The top infant is
labelled ‘smoker’, the next ‘sex addict’, ‘criminal’ or ‘drug user’. And the implication is, it’s all
in your genes. Yuck, I’ve had a
good lunch, and I feel sick! It’s
terrible. And it needs attacking.
This is a popular magazine and it is a popular view and it’s a total
disaster.
[slide of Mad in America]
This is an astonishing book and everyone should read
it. If you don’t, you’ll miss the
full story of the brain-doctors that we have been talking about. Brain doctors turn you, me and all our
patients, into mindless unfeeling robots. And it’s time we said we don’t want that. It’s time we
said let’s have something different.
It is very, very curious.
Human beings learn what they’re taught. You learn English, because your carers speak English. You learn that emotions are benign, or
you learn the opposite. You need
to learn that there is a pattern and a way through emotions.
The bulk of my book, Emotional Health, is relating to the
definition of what is an emotion.
People get very tangled about this. An emotion is something which you display. You don’t distinguish between a car
that’s parked, and a car that is mobile – it’s the same car. But it matters a great deal where
the car is moving, what the car is doing.
You don’t say we’ll deal with motion of the car today – you don’t,
you just deal with the car. That
is same with human beings, a human being that is moved by fear, moved by anger,
moved by delight, moved by joy.
And that is what people need to learn, whether they are taught at birth,
or from emotional education.
And here we come to Ethan, of course. At 17 minutes old he sticks
his tongue out in response to his dad.
I never stuck my tongue out to my infants, and I bitterly regret that. It is very sad. So I cheer myself up from the fact that
not only do I relate very well now of course – but that grandchildren who
are a positive delight. And that
human beings are so resilient.
It really is astonishing.
All infants require sound parental attachment. Where it is robust, childhood trauma doesn’t matter. Every child falls over, every
child hurts themselves. Some
children break their arms, some children’s parents die, dreadful things can
happen. What happens next?
If you get good support and people you trust and powerful
people pick you up, and say “well, you’ve broken your leg, your mother’s died,
but it’s all right the world is going on and we can help you”. That is support. Because where it’s not, you are in
trouble. This is scientific,
experimental, objective, measurable, demonstrable, weighable evidence. Here is the monkey [on the slide
projector] and the caption says, “monkey raised in partial isolation from birth
to six months bite themselves”.
This is self-harm writ large.
They are very aggressive, why should they not be? They’ve never learnt that society
matters. There is your picture,
there is the monkey biting itself.
Now if I could get hold of Harlow’s video that would be something,
wouldn’t it.
The earliest experiences show that attachment plays a vital
role in your resilience. Look at
this as the language you are learning in infancy. If you learn the mandarin and you happen to be in England,
then you are going to be at a disadvantage. Similarly with the emotions. And the sovereign remedy for all trauma is support. Pick the child up, pick the bereaved
person up, pick up the person who has been abused, or the child, pick up the
person who has been punished by the criminal justice system. And what emotional education does
in my book, is supply support.
It is what you do, you go and say “it’s all right, I’m strong. I’m waiting for your consent. But I’m supplying support”.
I have a beautiful video of a 27-year old woman who is
suffering from bipolar disease, manic depression, that is to say there are
times when she is extremely slow and down and difficult. And other times she will be all
over the place, and buying up all the teddy bears in the high street, round the
shops, manic depression. And
I have been seeing her for a while, intermittently, a couple of years ago, I
think it was and she was going slower and slower. And I said to myself, ‘Ooh, this person should
be in hospital. What are you
doing, this is terrible!’ Ten
minutes later, I said, ‘what we were talking about before?’ She says slowly ‘we
were talking about my mother’.
‘Yes,’ say I. ‘that’s right.
What were we saying?’ ‘I
miss my mother’. So I said ‘what
do you miss her for?’ I’m trying
to bring in today’s reality. ‘Well,’
she replied, ‘I want her to cook me good food,’.
Her mother died when she was six. Nobody said, ‘your mother has died. The world doesn’t come to an end’. And she moved into the maternal
slot in the family, her father wanted her mother, so on and so forth. That was the first time, twenty years
later, when we were actually able to address this, and at the end of that hour, she was bright and she was
bubbly. Two days later when
she came in, she was a different personality. Now that is psychosis, that is manic depression. That’s in your genes ? She was on the same drugs,
during, before and after.
And she’s revved up going with support.
That’s what I just said before, the intimate relationship needs
replicating in adult life. Modifications need to be made, since adults have
different needs and attributes than do children. And that leads to the key phrase: parenting keeps
infants alive and adults insane.
And what that means is, that if you don’t look after the infants, they
don’t thrive and if you really don’t look after them, they die. And the old story they put them on the
hillside and that was the end of them.
But adults are different. Adults have a different survival system they have a
different mechanism, a different life support system and that depends on their
self esteem. It depends on if
anybody has asked there consent. I
used to have great fun in Parkhurst prison, going round and saying ‘come and
see me tomorrow at 11 o’clock’.
They had nowhere else to go, it was a maximum security wing. ‘Oh, can’t see you tomorrow.’ ‘Oh fine’. This is consent.
You are in charge.
Whether you keep that appointment or not, is entirely up to them. And I had to learn not to
be upset, I had to learn to empower them.
Because that’s the difference between parenting, and a ‘plumbing’
relationship. Basically I’m
an emotional plumber. I go along
– ‘Do you want your emotions fixing ?’ ‘No. Get out of here’
‘Fine’.
I was different from a parental situation. Because I could acknowledge that, I
could say fine! And of course the
ace in my pocket was Lenny, who had changed in a short time, four months. So I thought well, it is possible. And some of them tried to prove
it wasn’t possible. Some of
them were extremely challenging.
But that was the way I had to empower them. These are some of the problems with attachment. Your get misperception, so you get
Lenny who sees his mother as big and strong, who sees his mother as a
continuing threat. His body
language to begin with was hunched.
His personality development was certainly pinched. He was fearful, his self-esteem
and self confidence were vanishingly small, as you saw in the dialogue.
I just want to close by tightening the analogy with a
broken leg. If you break
your leg, you need a crutch.
Fine. You don’t have it
forever. Nobody patronises you by
giving you a crutch, and then tells you where to walk. And everyone expects you to get better. You break you leg and people expect you
to get better – the expectation is there. Everybody expects that, so what goes wrong? Mental illhealth needs to be exactly
the same. It needs a
conviction, that it wont be forever, episodic, a conviction that you can
manage, you are not going to be told what to think, and what to consent
to. Everyone should expect
you to be better shortly. Not only
mental illhealth, but faulty adult attachments. So many marital situations that I saw in general
practice, (that is the wonderful thing about general practice. I was really called the family
doctor.) And so often you find
that a person gets married and wants to replace their parents, the father or
mother. And they don’t see
the person they’ve married for what that person is. And they need to clarify the situation, and see tat you are
two individuals struggling with life’s problems. But you are not a parent to the other person.
What I manage to do is a transformation. There is nothing more exciting,
more stimulating in my life experience, than watching an individual
blossom. They are loaded down, and
they are only two years old.
And they are totally hopeless. And if I can catch that on video, and describe
it, I won’t be doing too badly.
How do you heal a broken leg? Well, how do you heal a broken in mind? How do you
heal a broken relationship.
Here’s the answer – sound attachment. It’s most peculiar. If you want to heal a broken leg, all the doctors do is to
hold the two bones together. Stop
them wandering about. Hold them
together and then you wait.
And the little cells grow across and heal the bones. The doctor doesn’t heal the bones. The patient heals the bone. And if you don’t give them enough
calcium and enough food, it doesn’t happen. So you sit them there and support them – and the bone
heals.
It’s the same for a broken relationship. Sound attachment. It’s a wonderful idea. The point is support to the trauma.
[close.
Applause]
So what I would like to do is to ask the speakers including
Claire to come up on to the platform.
[Audience – ]
e.g. providing environments without drugs?
[Robert Whitaker]
What can I say?
Basically no. The question
is that in the United States, if a psychiatrist tried to treat someone
diagnosed with Schizophrenia without the use of drugs they would probably be
sued. For not taking care. There are a number of groups trying to
move forward and develop the secure house, to give them a chance. The chance is to make that option
available. There are probably 5-6
groups trying to do that. The most
advanced group moving along is a group from Alaska, a guy called Jim Gottstein
who has a website called psychrights.org. And just to say briefly, Jim is a lawyer who also had
his time as a patient consumer. If
he won a law suit in Alaska.
Someone had donated some land which was to supposed to go to people, the
value of that land to people with mental illnesses. Basically the state grabbed that land. Jim did a lawsuit, he wanted a
settlement.
In Alaska with a dual governing mental health board. There is your usual mental health
board, comprising psychiatrist, bureaucrats etc. And there is a second mental health board that also
sets policy, and is basically formed from consumers. So there we now have at the level of policy formulation, a
consumer voice which makes for a very interesting place. Jim actually got to Alaska on two
different timings. He presented
the information I presented today.
So it is like I said today, what is the evidence for this, for the use
of neuroleptics and schizophrenia.
What were the results of the Soteria house ? Has it been replicated in anyway? By the way, there have been Soteria
houses set up in other
countries. And they came up
with the exact same results? The
same as Switzerland. The findings
were and I quote, “surprisingly those patients without drugs have significantly
better results”. And the person running the Soteria house wasn’t really
expecting this.
Anyway where they are now in Alaska is, believe it or not,
we have got the psychiatric establishment to sign off on and say let’s give it
a try. That we should do
this. For some reason they can’t
quite bring it to fruition. And
partially there is this liability question because, if you want a psychiatrist
tied to the home, but the psychiatrist is fearful that if anything goes wrong
he could get sued for not providing the medication. So we all know that if you provide medications and things go
wrong, you don’t get sued. That
seems to be one of the stumbling blocks. But that’s the most far along programme.
There is also a group called the Freedom Centre in West New
York which is a group run by ex-patients, a very smart, able, energetic group
and they are trying to put together a Soteria house as well. They have some funding
problems. But I’ve given about 100
talks, I never had anyone say – here’s where you are wrong, here is where
you information is, you have this wrong.
None of the facts I’ve presented have ever been challenged and yet the
answer to this question is there is no change in the United States. We can’t seem to do what the evidence
suggests we should do. So the
answer is no, they are not providing environments where patients can be treated
without drugs.
[Bob]
I mentioned before, I want to get a public debate on ‘Dump
the DSM’. Just reading
through the preface and introduction it’s an exercise in wishful thinking. And would fail any philosophy
exam. It’s the same sort of
sophistry and false reasons that we have heard earlier on and I am hoping in
the next twelve months to organise a ‘Dump the DSM’ debate. And I am going to
challenge the Royal College of Psychiatrists to put somebody up to speak for
and then hopefully to put up a series of people to speak against. If the general public knew the
contents of the philosophical or ideological basis for the way psychiatry is
run, they would say, just a minute.
It has taken me twenty odd years to appreciate that if you say that to
psychiatrists they say ‘so?’ We
can sack you and they do. To the
public and consumers this needs to be pointed out maybe it will make a
difference.
It is endemic in our culture that we demonise
children. How many people hate
them? The first thing people ask,
‘is your baby good?’ What does
that mean. ‘no, it’s bloody terrible, bloody awful’. We do culturally demonise our children. And that does need to be changed. In terms of research and practice, Allan
Schore in America is in his 27th year of a longitudinal study based
on babies. There is a book coming
out shortly, they are looking at babies of the original babies so they are on
second generation now. There is a
range of outcomes and different parenting styles. And that does conclusively prove that cycles are
repeated. But equally can be
broken, if support is in place.
[Helen]
Can I just say that also the TV companies have a lot to
answer for because they go for the quick fix type of parenting. And although it seems to make
great telly, exciting telly, this supposedly is how family life is, which is
strange because that sort of power, we’ve had to fight against that. But the TV companies don’t feel
that is the way to go at the moment.
But we keep on banging against the door and hopefully produce a
programme that parents will learn things in a different way.
[Clive]
There’s a issue that comes up quite a lot with this about
crying and control crying which Gina Ford doesn’t actually recommend below the
age of six months. That
there is a thing that you are sometimes making a rod for your own back if you
don’t respond to the cries of the baby which after all is only trying to stay
alive. At a younger age it is very
damaging because the baby learns very quickly that, if I cry, there is
absolutely no point because nothing happens and they then become self-reliant
and develop all sorts of anxieties which may not manifest themselves in the
short term, but most certainly do in the long term.
Her system and systems like that do work, super nannies
etc. They are very successful and
they do make good television because you can dominate the child and actually
suppress it to a point so after a while it will become compliant. As were most of the people building the
Burma railway. You can manipulate
people, but I don’t think in the long term it does a great deal of good.
[Audience Question]
[laughter]
[Clive]
That’s what I wanted to ask!
[Sue]
And that you blame women for violence.
[Bob]
My experience of my mother ? You’ve picked the wrong one. It’s my experience with my father. I don’t blame mothers. Lenny’s mother battered him, in a
sense, but the thing about Lenny was that his father didn’t. I spoke to him on Wednesday and
confirmed this point. His father
was in the background and was supplying attachment, a secure place that Lenny
could relate to. He never had a
negative or antagonistic relationship with his father. He did with his mother, as you
saw. And that saved my
bacon. Because most of the other
inmates were very much more damaged than Lenny, and were more difficult to
reach.
Parenting is a very difficult skill, it can be very
difficult. And the problem
with it is that untutored you reproduce the parenting that you
experienced. This is how children
need to be. If I merged my mother
and my father together and if I tell you there were both Edwardian
schoolteachers. And the bell
rings and you are there that’s OK.
But if the bell rings and you are not there, then you are a very naughty
boy.
I was a single-handed General Practitioner, and ten years
into being a single-handed self-employed, nobody owned me, I remember
distinctly driving to work in a urban-rural setting, down the hill, round the
corner to my surgery and it was already a minute to nine o’clock. The bell goes at nine, and I
should be in the surgery waiting.
And I said to myself ‘What’s going on? There is nobody else. I am self-employed, this is my show,
if I go in there at ten o’clock and say, “sorry folks, I got held up,’ and they
would say ‘that’s fine, that’s fine doctor’. And that’s what helped me is the lift from the patients who
were in the waiting room and I knew for a fact by then that, that’s what they
would say. And so I thought,
where is this coming from? Tick. Tick. Tick.
My parental influences. And
I was frightened of my father, a very principled man but he had a temper and
you didn’t want to be on the wrong side of that temper.
And I couldn’t discuss with my customers, my consumers,
whether they were frightened of their parents. I couldn’t discuss it.
I was in a New York state hospital, treating drug addicts and I allowed
them to be angry, anger was fine.
But I couldn’t discuss fear.
And at one stage I would like go back to those tape recordings from the
1960’s and see how fear came up, and see what happened when it did.
The question about women – there’s a trap here which
is easy to fall into. When I was
very young, I said right let’s see if it’s always Mum. Gender fades, gender fades away
and when you are dealing with particularly difficult people that is damaged
people, often you will find that they are prepared to talk about, for example,
their father. One man in the
prison, for instance, had processed his father, and become independent of his
father. And then when we started
talking about his about mother, he threatened to kill me. He was a serial killer, and he
put me at the top of the hit list.
He practised garrotting his pillow, and decided to ask for a further
session with me so that when I turned to put on my video camera, that was the
end of me. And that’s
because we had started talking about his mother.
You don’t know.
You don’t say, it’s always Mum, you don’t say it’s always Dad. I don’t blame parents. Parents are not
deliberately setting out to destroy, they don’t know. You saw a wonderful demonstration [in the earlier videos] of
throwing the tray back and forth, ding, dong, it’s a wonderful game. And somebody asks ‘Do you need to do
this ?’ And she says ‘perhaps
not’. She is not saying that
I am going to screw up my child, give them hell, give them wonderful drugs, a
wonderful psychiatrist, she doesn’t say that. She just reacted.
That is what the bulk of the parents of the people that I treat,
do. Even the
abusers, they are treating the world in a way they have been distorted to treat
it. I don’t condone this, I never
condone it. Any form of child
abuse is destructive and is destructing our futures. But they are living out the programme that they have been
given, without the opportunity to adjust.
I have treated paedophiles and I have treated them successfully. But I don’t treat the sexual side
at all. The sexual side is the
mere symptoms, the mere flutter, and if you concentrate on that you are
sunk. You have to go
beneath that. You find revenge,
you find hate. And
underneath both of those, you find terror.
If you think about it, why do paedophiles do this
activity? It’s very destructive,
it’s obviously very destructive to small people. If you talk to them as I have talked to them, you find that
they daren’t be destructive to large people. They have to be destructive because they’ve got this revenge
inside them for their early infantile experiences, and if you access that and a
lot of paedophiles are glib and successful at hiding it. But if you can access it, you find
buckets of fear and you need to empty it.
[Audience Question]
not needing a parent, when they have never had any good
attachment relationship?
[Claire]
Well, my gut reaction to that, is that at two or before
that you make an attachment and if you are able to do that when you are little,
then when you get older, you learn how to make an attachment, because if a two
year old can do it, a 45 year old certainly can. They can learn how to do it, but they need a teacher. They need someone to show them how. And that’s what makes me very sad
when people come up to me at the conference at lunchtime and they know people
who are suffering, and they haven’t been able to make an attachment. I have been lucky enough to meet people
who can help me. And I
believe that they have shown me how I can change, but they haven’t done it for
me. So I have had somebody
to observe. And what makes
me feel sad, is that if other people don’t take this on board, how are they
going to get the help.
I don’t know how else to describe it. I faced the fear, and realised I didn’t
have a secure attachment but everybody had fears. And somehow having the support to put that all
together. I’ve observed it
in people like Nada and [Tony] and people who’ve been up here.
And I saw that in them at a conference like this. And that’s what made me get
in touch with Bob and Sue. I think
too it that you somehow have personalised it, and taken the risk that Bob was
talking about, and let us take responsibility for that person.
[Bob]
I think that’s a very good reply. It fits in with the way I see it, which is that it is
education. You learn to skate if no
one has ever shown you what skating is. The phrase is – it’s simple but it isn’t
easy. Here you are independent,
you make your own decisions and you exercise you own personal choice, but you
value your own life, in a way you weren’t valuing your own life.
[Robert Whitaker]
Just to build on what you are saying here. Go back to when
people were saying. The whole
point was they were building upon the therapy around other things and the
principle of a Soteria house.
By the way you can go on to Soteria.com or Soteria.org and pull out a
video of the house. I’m not going
to be as eloquent as you just were.
But one of the principles was – how do you help people get
well? In this house they would
have, I don’t know the language here, they would have people that weren’t
distress living in the house.
And people coming who were distressed. The idea was that it was human comfort, it was being
with each other, cooking together, play games, massage, listen etc, living
together and providing emotional support to each other, and its emotional . . .
treating each other with dignity, treating each other with respect.
And there is a great moment in a one of the Soteria clips
where one of the people who was newly entered into the house with the diagnosis
of schizophrenia, is certain that some aliens are going to visit this park,
this night, and he should be there because he is supposed to get on the spaceship. Now clearly this is a bit of a wild
idea. But instead of saying,
‘that’s crazy, stop thinking that way,’ the other people in the house said,
‘okay, let’s go to the park, and let’s see what happens’. So they go to the park, of course the
spaceship doesn’t show up and the guy says, ‘oh I guess their not coming!’
The point is that rather than apologise for everything
going on, it was a chance to give human support, human connection, respect and
not trying to set up this boundary between the well and unwell so much. Rather saying, and this relates back to
the old Quakers, that we are all brethren, so we don’t separate ourselves from
everyone; let’s recognise a commonality, and that was a guiding philosophy of
the Soteria house as a therapeutic principle. We recognise we are all human beings, which is what
you were just saying that humanness can be so nurturing and so
therapeutic. It’s not
‘non-drugs’ or the absence of anything that was being done.
[Bob.]
I remember the story in your book and I thought it was so
stunning, instead of saying you are a very naughty boy, there aren’t any
Martians, they say lets go see, meet the Martians, maybe they are green, you
never know. But
they didn’t come, and he took responsibility.
[Sue]
There are three questions here that I think are linked
together. What can we do about
career incentives that take priority over taking new information into
professional practice and that means that it career issues become more
important giving credence to new ideas in professional practice. How do we counteract the prevalent
attitudes in mental health, especially if we haven’t got ‘doctor’ before our
names? How much do we need to be
alarmed in the UK by the paradigm of care that is so medicalised, will medical
practitioners continue to be able to exercise clinical flexibility in the
atmosphere of the regulation of NICE, that is the National Institute for
Clinical Excellence guidelines, government white papers etc going to make
individualised care and treatment more difficult?.
So these are broader structural questions. And there was also one about the
new draft mental health bill implemented will contain legislative rulings
including compulsory medication in the community. Do you think such robust legislation is a bullies tool that
will damage the national psyche, it is so abhorrent?
Who wants to tackle those?
[Robert Whitaker]
Well I guess I’ll take a stab at starting. In terms of the scope of the problem,
the need for change, the thing throughout all of this was one statistic that
was the most powerful for me was this. In the United States, the number of disabled
mentally ill grows by 400 people per day, over 400 per day. That is a tragic loss. If we had 400 people suffering long
term decline because of the flu, or something in that degree of health problem,
we would do something about that.
And that is such a tragedy, that’s the only way I can put it.
The moral challenge is clearly out there. You see it in the every of society that
has embraced this paradigm. But it is basically the English speaking
countries, the UK, US and Australia.
Everyone now is experiencing an epidemic of mental illness. So the paradigm is clearly flawed. And this goes to the question
regarding professional practices, how do you challenge it if you haven’t got
doctor before your name. I honestly
don’t know how to do that because I know how it gets. If you are in a working situation where you aren’t the
doctor in the psychiatric institution.
You try and bring up this story that maybe what we’re doing isn’t
right. There is not a receptive
audience and you can in fact hurt your career. I don’t have a good answer for that. But I will say everyone here 400 people
per day, I don’t know what it is in the UK but I can guarantee you have rising
disability numbers. And if you
have rising disability numbers, that is a real horrible, moral to do
something. To do to wake people up
so to speak.
The thing is to make this more of a moral imperative is
that we now have it effecting childhood.
How we view childhood and how tolerant we are of children. If they fidget too much, well they’ve
got ADHD. You are robbing
that kid of their right to be, their right to grow up. The right to experience themselves and
see who they might be. That is a
profound fact; it’s out birthright – we need to find out who we are going
to be. Let us experience fully,
emotionally, life.
And that means being sad, difficult, fidgety, all those
things kids are. So we have a
two-stage problem in my opinion in society. First, we adopted this paradigm of care that led to this
rising number of disabled mentally ill. And now in the pursuit of making profits, expanding
the market we’re redefining childhood.
What is a normal child? And
we are robbing the kids of a chance to be. And I don’t know anything more profound than to fight
that, and to fight on behalf of the children.
So, my answer is, I don’t know how to do this fight. I thought the way to answer it was to
look at the evidence, the statistics, look at what is happening but that
doesn’t seemed to have worked. But
I do know this – it is a fight that needs to be waged.
[Bob]
I thought that actually persuading anorexics to eat and
self-harmers to stop that that would count too. But I was wrong, and it was a very hard lesson for me to
learn. So ‘doctor’ in front of
your name, may get you the job in the first place but then they shut the door
pretty fast, particularly if you start producing positive results, and the
patients like you. What you need
is this consumer movement. We need
a ground swell of public pressure to say look, you DSM toadies, the DSM is not
reflecting human nature. And the
drugs information that we have heard this morning is scarifying and people
should know that the drugs that are being prescribed by these very clever
doctors with vast qualifications and so on, are in fact producing long-term
disabilities. And they need to
know about it. And also that the
evidence is there that if you treat people with social therapies, Soteria
houses, therapies, discussing childhood traumas and so forth, they
improve. People need to know about
this.
I was invited to be Head of Therapy at Ashworth
Hospital. And they asked me
to go there. I was becoming
suspicious of civil servants, so I said ‘why are you asking me?’ ‘Well because of your brilliant work at
Parkhurst.’ I’d never
heard that phrase except on that occasion. And they wanted me there for three years. I said all right. They wanted to make a world centre for
treatment of Personality Disorder.
Which is great. I thought
‘right, let’s go for it.’ We went
for it, and I survived eight weeks!
Every single one of the 15 consultant psychiatrists signed a letter
saying that if I was not out of the hospital together with the chief executive
officer who was appointed at the same time, by 4 pm the next day, they would
issue a press release – resigning.
The NHS local regional board met and said let them go; the
national executive said let them go.
It went all the way up to Downing Street and they said, no, no, Johnson
goes. It took me a long time to
join up all the dots – it was in fact Tony Blair. Tony Blair said, ‘if we had an explosion
like this at Ashworth, [which definitely needs an explosion, I can tell you!]
then the tabloid press would say, you are a naughty boy, Tony Blair.’
So he said stop it. So he
in fact blocked my campaign there, otherwise we would be having a different
session today.
What needs to happen is the evidence, particularly that Bob
Whitaker has supplied, is that the public need to know. I am horrified by what happens in the
prisons. I am horrified by what
happens in the maximum security hospitals, horrified. We are talking about tyranny, we are talking about
torture in a way, a destruction of dignity, it’s common place. And the public needs to
know. But what we have got here is
so much more widespread. These are
drugs that are being prescribed as a matter of good practice as we’ve heard
– in case they get sued. And these people need to know that these drugs
are dangerous. Thank you for
supporting this and thank you for coming.
[Clive]
Very quickly, just on the line of the doctor, we always go
to events which are full of people with -ologies as we refer to them. And we don’t have any. And we have no formal training in
any of the work we do. We just
started out with an interest, picked up information, and your knowledge base
grows and you become more confident in what you are doing. But we always feel quite humble when we
come to something like this event, because we don’t have additional support,
only pieces of paper saying we are quite good at what we do and the fact that
we are all here is a statement in itself. And it does start from efforts from individuals. It doesn’t always come from trying to
persuade [Tony] Blair because he can ignore all of
us because he has his own agenda.
What makes a difference is a collection of people, like us,
networking, taking a little piece of what they have gained today and putting it
into practice in their daily work and that is what really does make a big
difference and, in time, it will get picked up by the powers that be. You need people to bang on the doors,
but you also need a whole army of troops that are actually going out there and
doing the nitty gritty. I wouldn’t
worry about not having any ‑ologies or doctors, you just get on with
it.
[Bob]
I’d like to thank everyone for coming, all the panel, and
for the questions. Thank you very
much.
End of conference.
For further enquiries please contact
James Nayler Foundation
P
O Box 49, Ventnor, Isle of Wight, PO38 9AA UK
e-mail admin@TruthTrustConsent
or our website at
[please note new
address – the office has moved from York]