#1
let's talk about lacan and klein here friends https://joannamoncrieff.com/2018/01/15/guest-blog-the-388-a-psychoanalytic-centre-for-the-treatment-of-psychosis/

The 388

For more than 30 years, the “388” has been a haven for people struggling with psychosis. A humble Victorian-Era house sitting amidst a bustling neighbourhood of Quebec City (Canada), this unique clinic is dedicated to providing an integrated, psychoanalytically-informed treatment of psychosis to willing users. Now considered by patients and families alike as a pillar of community treatment, it is still today one of the few places where patients can be “ accepted as are, for what may become. ”

Since it opened in 1982, the main goal of the “388” has been to deliver an alternative, yet state-of-the-art, therapeutic approach to young people suffering from schizophrenia or related disorders. How did the “388” achieve this? First and foremost, its founders began by challenging the longstanding assumption that psychosis cannot be treated with psychoanalysis. In order to allow psychotherapeutic work with psychosis, they had to create a new theoretical framework, which was based on their previous clinical experience with patients as well as on Freudian and Lacanian psychoanalytic therapy. The specifics of how they managed to integrate this clinical experience with psychoanalysis is beyond the scope of this article, but is detailed in numerous publications (see the references below for details). This theoretical stance is fundamental to the centre, as it informs the perspective of the whole team and thus provides a common understanding of the problems encountered by users.

“In the end, the most fundamental thing that psychoanalysis has brought to me is the freedom to stop destroying, and the freedom to start constructing.”
However, patients are not required to undertake a psychoanalytic therapy in order to start attending the centre. Psychoanalysis is indeed the cornerstone of treatment, so all users will be invited to engage in psychoanalytic work at some point. Still, psychoanalysis is only one part of a holistic approach including regular psychiatric follow-up, patient and family support by a team of mental health workers, art workshops with professional artists (engaged in music, visual arts, writing, drama, ceramics, etc.) from Quebec City, and many community-based activities (such as cultural activities, sports, etc.) that promote social integration. Users can also get involved in collective projects such as participating in biannual camp stays or by organising trips (for example, in 2016, some users self-funded a trip to New York City).

“What is mental illness? It is a feeling of exclusion. That’s my problem: I feel excluded.”

Group integration is a crucial part of helping patients: from a psychoanalytic standpoint, one of the main aspects of psychosis is that it loosens the bond between subjective experience and social reality. As social reality is, at least in part, collectively constructed and reinforced, people with psychosis may tend to become isolated and excluded from their communities. Furthermore, because this social space becomes persecutory, they might not understand how they could manage to give a voice to their own aspirations inside it. Hence, the “388’s” structure is entirely oriented towards promoting the reinsertion of psychotic individuals into the social link. What makes this “reinsertion” different from traditional social recovery therapies, though, is that it aims to support patients in their attempts to take part in social life, without giving up on their inner desires and aspirations. This orientation is directly drawn from psychoanalysis: the aim is not to extinguish one’s quest, but to promote it, and to articulate it within a group or society. It is for this reason that the spatial layout of the clinic is itself designed to promote integration: users can socialize in common living rooms, are invited to cook together, to share meals and so on. In terms of social integration, the combined work of patients, families and staff has yielded results. Based on the most recent data, after three years of treatment, the number of users who are active (working, studying or volunteering) rose from 24% to 71%, and the majority (56%) became financially self-sufficient (compared to 28% before entering treatment) .
“What I like about the 388 is that it is a house that is more open to external life, which does not marginalize us, which does not isolate us, which does not cut our ties with the outside world. Here, I feel like I am rebuilding my life in a solid way, with better perception, a better guide to face external life.”
One of the main goals of the team is to avoid hospitalisation. Accordingly, in addition to regular outpatient psychiatric care, the centre is open 24/7 so its staff can answer phone calls and provide more intensive social support when needed. If this isn’t enough, 4 bedrooms (with 5 beds) are available for short-term stays during acute crises. The idea behind this is to allow users a safe and open environment to work and reflect on their crises as they emerge, so that they can ultimately understand the meanings of the crises, and manage their crises with new tools. Those measures, combined with the clinic’s integrative care, allow for a significant reduction in hospital stays: throughout their first three years of treatment, users spent 78% less days in a hospital than compared to the three years before they began attending the centre .
“During my last hospitalisation, I told that I was hearing voices: “Oh, just don’t pay attention to them !” If I can’t talk about them, if I can’t approach them, learn to deal with them, try to understand them, try to understand what they are doing here, their reason, their cause, if we don’t treat them, imagine the consequences of a psychosis, after which we end up in the hospital twice a year!”
A psychoanalytic approach to psychiatric symptoms can sometimes diverge from the neurobiological perspective, particularly when it comes to the meaning of these symptoms. Psychodynamic therapists generally tend to explore the inner world in which symptoms arise, guiding the patient to gain knowledge about the meaning of symptoms. At the “388”, psychiatrists share this attitude towards psychotic symptoms and extend it to their understanding of the role of antipsychotic drugs. Even if there is absolutely no forced treatment in the centre, psychiatrists still follow up-to-date pharmacotherapeutic guidelines. However, they may focus on patients’ attitudes towards medication, exploring their perceptions and trying to reach an agreement before prescribing. The purpose behind pharmacologic treatment isn’t necessarily to eliminate symptoms per se, but to reduce them enough to allow for self-direction, creative activities, psychotherapy and social integration.
“A comparison: drugs are a little bit like a band-aid, and when you pull the band-aid off, it bleeds again. With psychoanalysis, you don’t need a band-aid anymore, the wound has healed!”
Predictably, because of what may seem like political, ideological or economical reasons, since its foundation the “388” has been somewhat marginalised by traditional psychiatric institutions. In the beginning of the 2000’s, the “388” had to fight for its very existence: critics argued that it should close, as psychoanalysis is irrelevant. In response to these concerns, in 2002, an independent committee was appointed by Quebec’s Health Ministry to settle the debate. Through its study, the committee concluded that considering the excellent quality of medical care, the global approach and the high rates of satisfaction among users and families, the “388” should preserve the program as it was being administered. It is indeed what the “388” did, and what it intends to keep doing. Yet, because of substantiahttps://joannamoncrieff.com/2018/01/15/guest-blog-the-388-a-psychoanalytic-centre-for-the-treatment-of-psychosis/l reforms being carried out in the mental health field in the province, the centre’s current form may again be jeopardized in the upcoming years. We may however remain optimistic, for though the center has gone through many trials and tribulations, it has survived, supported by the trust of patients and their families. In these terms, we may conclude this brief presentation of the “388” by reflecting on the words of one user:
“I think that at the 388 they believe in the power of humans, in the humanism that inhabits in all of us and that everything is possible with this humanism, with this humanist approach which gives us back our dignity and our self-esteem. Step by step, we reconstruct then we recreate our lives.”



recommended reading, by no means exhaustive:
-A Clinical Introduction to Lacanian Psychoanalysis, The Lacanian Subject
Bruce Fink is a practicing analyst and writes very clearly about Lacan from that persepctive
-After Lacan: Clinical Practice and the Subject of the Unconscious
Collection put together by GIFRIC members, the group that runs the 388
-Contemporary perspectives on Lacanian theories of psychosis
-Second Thoughts
Collection of essays by Wilfred Bion, his theories of psychotic thinking are fascinating and off the wall too
-Anything put out by ISPS
-Ordinary Psychosis and The Body: A Contemporary Lacanian Approach 2014th Edition
Cool investigations of 'mild' psychoses
-Operators and Things: The Inner Life of a Schizophrenic
Absolutely captivating first-person narrative of psychosis, definitely recommend
-The Subject of Psychosis: A Lacanian Persepctive
Covers one of the two major contemporary Lacanian theories on psychosis
-On Being Normal and Other Disorders
Cool book on Lacanian psychodiagnostics
-Schizoid Phenomena, Object Relations and the Self
Harry Guntrip is one of my favorite object relations authors. Talks about schizophrenia and related disorders from an object relations perspective
-The Divided Self
Classic existential psychoanalytic text

fellow psychotics, lets get readin

#2
feel free to post about mind control conspiracy theories here, as well. i understand
#3
jansenist_drugstore had recommended "Psychiatric Hegemony: A Marxist Theory of Mental Illness" by Bruce M. Z. Cohen earlier this year, maybe they can talk more about it
#4
i did post about that book and it is really excellent. i am too busy to say much more about it right now but i highly recommend it. it deals more with the institution of psychiatry than psychoanalysis, but cohen has some excellent insights that go far beyond most criticisms. i said in the other post about it that, as a result of cohen not being within/affiliated the field, he manages to maintain a dialectical criticism of the medical hegemony that differs from other people working in so-called critical psychiatry. its on libgen i think.

otherwise i would group-read/discuss lacan's four fundamental concepts of psychoanalysis if you or anyone else would be interested. it would be a re-read for me but i did not get a solid grasp of it because i read it exclusively on the el in chicago lol

kinch introduced me to christopher lasch a few years ago who is also very excellent. i am finishing up his book "the minimal self: psychic survival in troubled times" right now and it is fucking fantastic.

#5
Psychoanalysis for psychosis is essentially the centrist position of the institutional wing of the 60s and 70s radical and anti-psychiatry movement. The recent resurgence of this form of treatment over the last decade is simply an outcome of market research, once you get down to it. Patients don't want antipsychotics, never have, so the privilege of avoiding medication can itself be bought through acquiescence to verbal and social control marketed as treatment. Instead of going off the grid to hide from social services breaking down your door for forced community treatment, or family members performing Munchhausen by proxy, you get to pay for the privilege of going on parole.

Regarding the use of antipsychotics, here are some excerpts from Robert Whitaker's "The Case Against Antipsychotics"

A. Schizophrenia outcomes, 1945-1955

According to the conventional narrative in psychiatry, prior to the discovery of chlorpromazine, people diagnosed with schizophrenia were destined to becomechronically ill and confined to a life inside the mental hospital. The natural outcomes for people so diagnosed are dismal, and thus any treatment that improves on this outcome is understood to be helpful.

However, a review of outcomes for first-episode schizophrenia patients from 1945 to 1955 reveals a very different understanding. Specifically:

*At Warren State Hospital in Pennsylvania, 62 percent of first-episode psychotic patients admitted between 1946 and 1950 were
8discharged within 12 months. At the end of three years, 73% were living outside of the hospital.3

*At Delaware State Hospital, 85% of first-episode schizophrenia patients admitted from 1948 to 1950 were discharged within five years, and on January 1, 1956—six years or more after initial hospitalization—70 percent were successfully living in the community.4

*At Hillside Hospital in Queens, more than half of the 87 schizophrenia patients discharged in 1950 never relapsed during the next four years.5 There are three conclusions to be drawn from this data. The first is that a majority of patients hospitalized for a first episode of schizophrenia from 1945 to 1955 recovered within 12 months to a point they could be discharged. The second is that more than two-thirds of first-episode patients could be expected to be living in the community five years after initial hospitalization, and this was at a time when there was no disability system to provide financial support to people who are unable to work for one reason or another. The third is that only a third of first-episode patients would become chronically ill and unable to function outside the mental hospital.

Those were the outcomes for hospitalized patients diagnosed with first-episode schizophrenia in the pre-antipsychotic era. This spectrum of outcomes serves as a historical foil for the introduction of antipsychotics. And given the conventional narrative about the drugs’ merits, we could expect that the arrival of chlorpromazine and other antipsychotics would lead to an improvement in this spectrum of outcomes, a leap forward that would be captured by the research literature. The percentage of first episode patients who recovered and could live independently in the community, without government assistance, could be expected to increase.

B. Research from the 1950s to 1980s

1) A paradox appears

In 1961, the National Institute of Mental Health conducted what it deemed the first well-controlled study of antipsychotics. In the trial, which was conducted at nine hospitals, 270 patients were given chlorpromazine or another phenothiazine (the chemical name for first-generation antipsychotics), and 74 were randomized to placebo. At the end of six weeks, the drug-treated patients had a greater reduction of their psychotic symptoms, and, in general, were doing better than the placebo patients. This was evidence of the drugs’ short-term efficacy.6

However, many of the placebo patients also improved during the six weeks. Most of the patients were then discharged and followed for one year. At the end of that time, the investigators were startled to discover that “patients who received placebo treatment were less likely to be rehospitalized than those who received any of the three active phenothiazines.”7

Here, at this very first moment in the outcomes literature for antipsychotics, there is the hint of a paradox: While the drugs appeared to be effective over the short term, perhaps they made people more vulnerable to psychosis over the long term, and thus the higher rehospitalization rates for drug-treated patients at the end of one year.



4) Experimental studies in the 1970s

During the 1970s, with questions about the merits of antipsychotics hanging in the air, the NIMH funded three studies designed to assess their longer-term merits.

A) Agnews State Hospital study

In one study, Maurice Rappaport, at the University of California in SanFrancisco, randomized 80 young males newly diagnosed with schizophrenia at Agnews State Hospital into drug and non-drug groups. Although symptoms abated more quickly in those treated with antipsychotics, both groups, on average, stayed only six weeks in the hospital. Rappaport then followed the patients for three years, during which time they could choose whether to take an antipsychotic. As such, he ended up with four groups at the end of three years:

a)those treated without antipsychotics in the hospital who stayed off the drugs during the follow-up.b)those treated without antipsychotics in the hospital who then used drugs in the follow-up.

c)those treated with antipsychotics in the hospital who got off the drugs in the follow-up.

d)those treated with antipsychotics in the hospital who stayed on the drugs during the follow-up.

At the end of three years, it was the first group—the never-exposed-to-antipsychotics group—that had by far the best outcomes. Only two of the 24 patients in this group relapsed during the 3-year follow-up (8%.) In contrast, the patients that arguably fared the worst were the last group—those on antipsychotics throughout the study. Seventy-three percent of this group had been rehospitalized.

Given this data, Rappaport and colleagues drew the obvious conclusion. “Our findings suggest that antipsychotic medication is not the treatment of choice, at least for certain patients, if one is interested in long-term clinical improvement,” they wrote. “Many unmedicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer rehospitalizations, and better overall functioning in the community than patients who were given chlorpromazine while in the hospital.”11

As can be seen, a majority of patients randomized to the no-drug arm in the hospital were able to recover and did well over the long term (24 of 41 treated without medication in the hospital). That outcome also echoed findings from the pre-drug era, when roughly two-thirds of first-episode schizophrenia patients would be living in the community five years after their initial hospitalization



1. Cross-cultural studies

In 1969, the World Health Organization launched a study that compared schizophrenia outcomes in three developing countries, India, Nigeria, and Colombia, to outcomes in the United States and five other developed countries. At the end of five years, the outcomes were much better for patients in the developing countries.32

This result stunned the WHO investigators, who struggled to explain the reason for this disparity in outcomes. The WHO launched a second study, two years in length, and this time they decided to measure usage of antipsychotics. The researchers hypothesized that perhaps patients in the developing countries were more medication compliant, and this was a reason for their better outcomes.

The results in the second study were much the same. At the end of two years, nearly two-thirds of the patients in the developing countries had good outcomes, and slightly more than one-third had become chronically ill. In the rich countries, only 37 percent of the patients had good outcomes, and 59 percent had become chronically ill. “The findings of a better outcome of patients in developing countries was confirmed,” the WHO scientists wrote. “Being in a developed country was a strong predictor of not attaining a complete remission.”33

However, the medication hypothesis did not pan out. In the developing countries, the researchers reported, only 16% of the patients regularly took antipsychotics, versus 61% of the patients in the developed nations. The outcomes were the best in India and Nigeria, where usage of medication was the lowest, and the worst in Moscow, which had the highest medication use and highest percentage of patients who became chronically ill.34

In 1997, the WHO investigators interviewed the patients in the two studies once more. After fifteen years, the “outcome differential” held up for “general clinical state, symptomatology, disability, and social functioning.” In the developing countries, 53% of schizophrenia patients were “never psychotic” anymore, and 73% were employed.35

The researchers didn’t report on medication use in this follow-up study. But the connection was clear: In the countries where few people had been regularly maintained on antipsychotics (16%), long-term outcomes were much better than in the countries where continual medication use was the standard of care.

That is a result consistent with the finding that, over the long-term, the medications increase the chronicity of psychotic disorders and impair functioning.



I'm done formatting text culled from a pdf, but the entire thing is worth reading, the text itself is only 42 pages.

#6
Regarding the effectiveness of psychotherapy as a treatment for psychosis, it should be taken into account that all of these group home treatments are basically patterned after Loren Moshe's Soteria, which was in essence a sanitized adaptation of one of Laing's experiments.

The problem, is, anyway, when you cross-examine the remission rates for these programs, they aren't that much higher than those shown in patients who tend to just go off the drugs. Highest remission rate I've seen for one of these programs was, if I remember right, 91% for Open Dialogue, a Finnish program which is still in development. Compared to the 73% re-entrance into the workforce in a developing nation population where 16% adhere to drug treatment, I think it can be safely assumed that psychotherapy has at best a negligible effect on the outcome of psychosis. The outcomes would probably be about equal if the fact that these programs typically aren't open to people who might be described as 'criminally insane' were to be taken into account.
#7
I can't find it at the moment, but there was recently an article published about differences in voice content in schizophrenics depending on culture. It compared, if I remember right, Indians and Nigerians to Americans. Americans were more likely to hear disturbing or unidentifiable voices, while Indians and Nigerians were more likely to hear supportive or friendly voices, often family or friends.

This is perhaps an area where psychotherapy could have an effect, in people who become functional while remaining mildly psychotic, but there are other factors to take into account.

The most promising treatment for psychosis is far and away the adoption of a ketogenic/paleo/zerocarb/carnivorous lifestyle.

In addition, despite the numerous urban legends surrounding the risks of unleashing latent problems through psychedelic use, some of the most compelling research into LSD and psilocybin prior to the scheduling of psychedelics centered around their use in treating mental disorders:

Childhood Schizophrenia Studies
Successful Outcome of a Single LSD Treatment in a Chronically Dysfunctional Man

I'm unfortunately not yet familiar with the work of Grof or others who experimented with psychedelic therapy.

Regarding more cultural divergence, there's an article floating around somewhere which made the claim that Hallucinogenic Persisting Perception Disorder was unheard of in the shamanic practices of Central American indigenous peoples.

I have extreme doubt that the differences in neurodivergent experiences in western society are due to social conditioning alone, given the relationship between the shift in nutrition and the rise in mental illness, and to resurrect a treatment which was only revolutionary in the context of a hegemonic practice of wantonly violating the Hippocratic Oath strikes me as a desperate gambit by mental health practitioners to preserve the religious positions of their discipline.
#8
one thing you will definitely want to avoid, I can't stress this enough, is opening fire on your sister and other patrons of a tavern in the Entertainment District of Dayton, Ohio, while shouting tHE r H i z z o n E catchphrase "The McRib is back" (copyleft G.L.T.)
#9
why do so many communists like lacan so much?
#10

jansenist_drugstore posted:

i did post about that book and it is really excellent. i am too busy to say much more about it right now but i highly recommend it. it deals more with the institution of psychiatry than psychoanalysis, but cohen has some excellent insights that go far beyond most criticisms. i said in the other post about it that, as a result of cohen not being within/affiliated the field, he manages to maintain a dialectical criticism of the medical hegemony that differs from other people working in so-called critical psychiatry. its on libgen i think.



I read the Cohen book after your mentioned it. You are right that he has insights that go beyond most criticisms, but then again he has some criticisms that go beyond any insight. The core of his argument is that 'psy-proffesionals' taken as an institutions are like the cops. In the popular imagination, cops and shrinks are doing a public service. Just like the cops, though, the institutions are constituted mainly by their role in maintaining class power. Cops and shrinks can't be reformed into doing the jobs we tell our children they are supposed to be doing. We have to scrap them wholesale and start from scratch.

I agree with him as far as that essential claim, which is already a radical one in most corners.

That said, Cohen is very cynical. I'm never going to take meds again if I can help it, but anti-psychotics are not unalloyed poisons.

Also, Cohen does not exclude psychoanalysts from the 'alienist' camp as far as I'm concerned.

#11

c_man posted:

why do so many communists like lacan so much?


aside from clinical applications, i also like people like lasch and TLP and arrghshell's blog posts (https://n0p3.net/) where she talks about narcissism

#12

c_man posted:

why do so many communists like lacan so much?



well i know that plenty of communists (who are at least as communist as i am by any practical measure) insist there is nothing in freud worth keeping. so i'll just speak for myself. i think i'm attracted to psychoanalysis on the basis that it not only claims to reveal the hidden content of an individual's processes (as they happen) but that it then offers a framework to decide how to move forward. i think that in lieu of an effective party the question of ethical activity is left up to the individual whether we like it or not. freud never said this though and it's just my modern adaptation. i'm just a fledgling student and i can't speak to lacan in particular so i'll just stop there.

#13

c_man posted:

why do so many communists like lacan so much?


#14
if you read any of my recs it's gotta be operators and things. its on libgen. seriously read it it owns
#15

graphicalUSSRinterface posted:

if you read any of my recs it's gotta be operators and things. its on libgen. seriously read it it owns


got it - i'll check it out and report back

#16

jansenist_drugstore posted:

c_man posted:

why do so many communists like lacan so much?


communists like lacan so much because of his truly incredible sense of fashion

#17

graphicalUSSRinterface posted:

if you read any of my recs it's gotta be operators and things. its on libgen. seriously read it it owns


nearly finished. extremely impressed. i'll write a longer response when i am done reading it

#18
i've been wondering for a few years what the social/community integrative stuff would do for someone dealing with genuinely severe dissociative traits, like huge memory gaps, personality changes, inability to integrate knowledge of past actions, etc. i think it's nice and helpful but not enough, though traditional psychoanalysis doesn't seem to have any good answer for it either other than "maybe do yoga or dance because somatic stuff helps and talk a lot". you guys have any thoughts?
#19

drwhat posted:

i've been wondering for a few years what the social/community integrative stuff would do for someone dealing with genuinely severe dissociative traits, like huge memory gaps, personality changes, inability to integrate knowledge of past actions, etc. i think it's nice and helpful but not enough, though traditional psychoanalysis doesn't seem to have any good answer for it either other than "maybe do yoga or dance because somatic stuff helps and talk a lot". you guys have any thoughts?


dissociation and dissociative disorders have their origin in the trauma-based modality and not so much PA, afaik. this book https://www.amazon.com/Psychosis-Trauma-Dissociation-Perspectives-Psychopathology/dp/0470511737 (it's on libgen) is a really informative read

#20
okay, i finished the book. i thought it was a really fantastic book and her account of schizophrenia was eye-opening. most notable to me was her omission of really any day-to-day activities during her six-month "trial" beyond subtle hints about having difficulty maintaining cleanliness and drinking a lot of coffee. that was one of the best parts of her account because of the otherwise banal experiences most people (i assume) would be compelled to include in order to convey their experience in a way that would be understood more as a survival-crisis of insanity rather than a long, strange and confusing process of dissociation. her reports of meeting psychiatrists and being turned away was interesting to me because i feel like the opposite would have happened at present, where nearly-endless admittance into a terrible ward would be the first option. it is interesting how psychological care has developed. i don't know if it is better or worse overall (excluding the obvious like lobotomy/extensive shock treatment/general torture tactics), but there is clearly a difference that would be nice to understand more, especially in the initial triage stages of treatment.

the end of the book tailed off for me, though was interesting in its own rite, particularly when she discussed refuting basically all theories of etiology, treatment and life post-treatment based on her own experiences. it is unfortunate that phenomenological research/therapy in psychology has essentially failed in its at least noble mission through succumbing to a positivist appropriation of corporate lifestyle coaching applied poorly to cognitive behavioral therapy for anything and everything. get in, get out, get nowhere, but at least know how you feel. i think that the phenomenological psychology of Laing had potential during the late 20th century but he did not anticipate the brutal bureaucratic turn in treatment across all medical conditions but especially psychological healthcare. i still stand by his writings in the divided self and appreciate his mission, but i think that he was short-sighted and overlooked the fact that he had a bad understanding of every philosophical approach to psychology he tried to use.

dr. cat, you're the doctor aren't you? what do you think? to your question, though, and speaking of Laing: he and his disciples heavily advocated "Encounter Groups" or "T-groups" for a number of years. this is similar to alcoholics anonymous in the sense that you meet with strangers and say anything, ask anything, do anything, as long as it isn't directly harmful to others/the general environment of the group. the rationale being that when dissociative experiences become localized in a group of regularly-meeting, theoretically as-honest-as-possible people the dissociative experience would become more normalized and subsequently less debilitating, frightening or difficult to manage. a lot of the reasoning is obviously silly and naive humanistic remnants of mass hippie culture, but i understand its potential to be social healing modality to some extent. a lot utopianism and a lot of child-like trust in others.

i'm now getting to the point of tautology if i haven't passed it already, so i'll finish with:

the book was good and i also recommend it. thank you gUSSRint for the suggestion.

#21
The thing about mental health professionals in the U.S. in recent years, speaking from my own previous professional experience trying to match them up with patients seeking treatment, is that they are perpetually cutting back/phasing out accepting insurance at all to the extent that they are able to do so within the group of patients they treat to sustain their practice. This is because insurers have a set recurring schedule for challenging and denying payments on the grounds of, Hey, if your treatment were at all effective, your patient wouldn't have to keep coming back for it.

This means most of their patients are paying out of pocket for their services or will end up doing that, that the patients with conditions stereotyped as treatment-resistant are coded dishonestly to avoid being flagged as liabilities for the insurer, and, of course, that mental health treatment is effectively maintained as a luxury service in much of the United States, outside of a measure of low-quality, overcrowded, underfunded care for a certain subgroup of SSI recipients, stuff that makes for good second- or third-tier fundraising copy for politicians. As far as the insurers themselves are concerned, they will show those covered a list of mental health professionals that are supposedly in-network, and most of the names on that list are either outdated and no longer accept that insurance or maintain themselves as in-network to drive a select group of patients to their practices but will not see new patients under most plans, since they've discovered the insurer works hard to transform the entire experience into a star chamber every few months.

It's the main reason I think the only way to fix health care in the U.S. is to physically eject Congress from their offices, however likely anyone thinks that is to happen, since most of the people in it or headed to it are partially dependent on some part of this system for campaign funding, a system that exists to make and keep doctors and shareholders wealthy. They just do horse-trading as to who within that system they are allowed to piss off without de-funding their own campaigns or reducing their income significantly when they retire through the revolving door into the lobbying or consulting world. Usually "Big Pharma" gets the short end of the stick nowadays for whatever reason. But when you have someone like Tom Daschle arguing for "single-payer" health care, you know the fix is already in, that the industry and their thugs are getting out ahead of a perceived threat to smooth capital churn, and whatever will result from it will be no real improvement for the vast majority of patients or potential patients compared to what's in place right now. It's redundant to say everyone at the top of this system will defend it through the use of physical force, because that's already what they're doing, and people are dying.
#22

jansenist_drugstore posted:

i think that the phenomenological psychology of Laing had potential during the late 20th century but he did not anticipate the brutal bureaucratic turn in treatment across all medical conditions but especially psychological healthcare. i still stand by his writings in the divided self and appreciate his mission, but i think that he was short-sighted and overlooked the fact that he had a bad understanding of every philosophical approach to psychology he tried to use.


Laing admits in The Divided Self that his approach is incomplete when he recognizes defeat in being unable to help the young man experiencing schizoid occultist delusions. His conclusions in The Politics of Experience are far different, and its superficially idealist perspective has been vindicated by science over the last decade. The overarching theme in Knots is also superior to the orthodox psychoanalysis presented in The Divided Self.

Wards aren't that bad, anyway, they should be retrofitted for extended stays and better access to outdoors spaces.

the rationale being that when dissociative experiences become localized in a group of regularly-meeting, theoretically as-honest-as-possible people the dissociative experience would become more normalized and subsequently less debilitating, frightening or difficult to manage. a lot of the reasoning is obviously silly and naive humanistic remnants of mass hippie culture, but i understand its potential to be social healing modality to some extent. a lot utopianism and a lot of child-like trust in others.


According to evidence this kind of approach worked, works, and will work, better than medication.

#23

c_man posted:

why do so many communists like lacan so much?



lacan's core concepts involve disavowed desire and how it can radically alter interpersonal/social behaviour, which is necessarily of interest to anyone left of tradicionalismo

#24

cars posted:

This is because insurers have a set recurring schedule for challenging and denying payments on the grounds of, Hey, if your treatment were at all effective, your patient wouldn't have to keep coming back for it.

This means most of their patients are paying out of pocket for their services or will end up doing that



that was also my experience both professionally and while receiving psychotherapy. in fact, i was seeing someone in-network, they stopped accepting my insurance without informing me, and sent me a bill for $1,500+ after a number of months, which is still sitting nicely unsettled in a collections account somewhere.

unsurprisingly, this is also the case in germany, i've learned. it is very challenging to get any treatment for psychological issues beyond 8-16 CBT sessions spread across a handful of months. i told my GP that i would like to receive psychotherapy and asked if he could write me a prescription for it, he said, 'no, try chamomile tea instead'. nearly all psychoanalysts are paid in cash, out of pocket. the very costly private insurance companies here will occasionally reimburse people for that service.

regarding the US: my view is that most people interested in psychoanalysis are not well-supported (if not outright discouraged) by PhD programs, where shoddy treatment plans and bad research run the show for the same economic reasons. so people get PsyDs instead which cost an insane amount of money, and then can't get hired at places beyond community clinics where they get pigeonholed with endless hours and terribly low wages. or they open private practices and can't get insurance companies to cover their services. it is a fucking mess, and you are all probably already aware of it.

AZ_IZ_OT posted:

According to evidence this kind of approach worked, works, and will work, better than medication.



totally. i was just getting at the fact that it requires a lot of faith in people otherwise unacquainted with one another being on the same page. like laing, i think it is a very good treatment along side psychotherapy.

#25
just finished psychiatric hegemony. wow that was extremely thorough

one thing i found strange is that he kept gesturing to "validity" or "proof of existence" metrics of "mental illness" when the entire work could be interpreted as an explanation of the scientific uselessness of these metrics. idk i was probably missing his point here. just seemed out of character to exploit psychiatry's own self-criticism outright (this paper essentially defines "validity" as "having natural boundaries", a requirement which the authors conclude is never met by psychiatry.)

i think i agree with belphegor regarding anti-psychotics. even by the end of the book i don't think the author was in a position to universally condemn drugs or techniques of therapy in general, yet he slides this in there at the very end: "Despite being no more effective than placebo, I know that some people still find these drugs useful." pretty weak concession i think

i have other issues but they're embryonic. for me the most important part of this book is the history. and it was really good so thanks for the recommendation! looking forward to reading more of what's been suggested here
#26
i keep starting to write things here and there in this thread and deleting them because i guess i'm at a point in my mental health journey where i feel like real progress is being made but everything is a bit raw right now. but i'm reading and appreciating the discussion here
#27
thanks for the dissociative stuff discussion guys. i have nothing useful to contribute but thank you
#28

nearlyoctober posted:

psychiatric hegemony



glad you liked it. imo his weakness is that he knows that his line on certain things (drugs/validity are two good examples) must be more moderate, but he is unwilling to concede to the real, current structure. i.e. psychiatric drugs have flooded bathroom cupboards everywhere and aren't going anywhere anytime soon.

psychiatry has no boundaries because it works from a normative ethic that is very flexible to fit in with whatever power structures are at play. its claims at validity are only ever theoretical, and any paper you could find for e.g. a drug trial will have a lengthy but vague limitations report at the end. it doesn't mean anything. diagnostic validity is much more complex because some people really want diagnosis and perhaps benefit from it. i don't know how i feel about that beyond feeling, on the one hand, skeptical and critical of systems that provide normative options for people experiencing distress, and, on the other hand, trusting people when they report feeling relieved at having some explanation for their distress.

one of my former professors wrote a cool open letter to the DSM V task force that gained a small amount of traction in the field. you can read it here: https://www.ipetitions.com/petition/dsm5

he and his colleagues are highly suspicious of the validity of diagnosis in general. he also wrote a decent book called "Drugging Our Children: How Profiteers Are Pushing Antipsychotics on Our Youngest, and What We Can Do to Stop It". its just an OK book, but it also provides a good history of medication practices and subsequent big pharma big business techniques.

#29

jansenist_drugstore posted:

psychiatry has no boundaries because it works from a normative ethic that is very flexible to fit in with whatever power structures are at play.



i think this is very important and makes it hard to come up with the line "psych(iatry/ology) has to be scrapped wholesale." admittedly it's hard for me to think clearly on this point because ᴍʏ ᴡɪꜰᴇ is a practicing clinical psychologist so i'm legally obligated to say that what she does is "useful."

but anyway my "embryonic problems" include the jabs cohen made at soviet/chinese psychiatry. so he writes off the soviet "sluggish schizophrenia" as a "labeling of political dissidents as mentally ill that intensified after Stalin's death." again it's my knowledge here that is embryonic. but what dialectical materialism obviously implies is that "mental illness" cannot be abstracted from the specific historical moments. there is a strikingly obvious class difference between "western schizophrenia" and "sluggish schizophrenia": the latter was employed to literally label anti-soviets/reformists as "mentally ill," and at least on paper that sounds pretty cool (even if terminologically unacceptable to the modern "mental health advocate"). from the book:

In fact, the belief in this label by Soviet psychiatry was so strong that when [Mikhail Gorbachev] began to speak the language of reform in the mid-1980s, some worried that he was showing all the signs of having this mental illness



i have a suspicion that lots of answers can be (have been?) gleaned from a study in this direction but unfortunately cohen refuses to engage. instead he comes off sounding like a liberal wikipedia contributor on this point.

#30
sup psychosis crew, i like to take my pills
#31

nearlyoctober posted:

jansenist_drugstore posted:


psychiatry has no boundaries because it works from a normative ethic that is very flexible to fit in with whatever power structures are at play.



i think this is very important and makes it hard to come up with the line "psych(iatry/ology) has to be scrapped wholesale." admittedly it's hard for me to think clearly on this point because ᴍʏ ᴡɪꜰᴇ is a practicing clinical psychologist so i'm legally obligated to say that what she does is "useful."

but anyway my "embryonic problems" include the jabs cohen made at soviet/chinese psychiatry. so he writes off the soviet "sluggish schizophrenia" as a "labeling of political dissidents as mentally ill that intensified after Stalin's death." again it's my knowledge here that is embryonic. but what dialectical materialism obviously implies is that "mental illness" cannot be abstracted from the specific historical moments. there is a strikingly obvious class difference between "western schizophrenia" and "sluggish schizophrenia": the latter was employed to literally label anti-soviets/reformists as "mentally ill," and at least on paper that sounds pretty cool (even if terminologically unacceptable to the modern "mental health advocate"). from the book:



In fact, the belief in this label by Soviet psychiatry was so strong that when began to speak the language of reform in the mid-1980s, some worried that he was showing all the signs of having this mental illness



i have a suspicion that lots of answers can be (have been?) gleaned from a study in this direction but unfortunately cohen refuses to engage. instead he comes off sounding like a liberal wikipedia contributor on this point.


its interesting that the discourse around soviet psychiatry is that is got more oppressive after stalin's death. that's sort of counter to the way most things are talked about, and you sometimes hear 'stalin had this guy committed to an asylum' or what have you as an anticommunist thing. so what changed? what were they actually doing under stalin? gorbachev being called mentally ill for being a revisionist is really funny, also

#32
Gorbachev was a pizza hut sleeper agent.
#33

tears posted:

sup psychosis crew, i like to take my pills



by all means, take them....















just Very Carefully

#34

c_man posted:

why do so many communists like lacan so much?





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Edited by Constantignoble ()

#35
self-realizing how fragile the mind is a harsh lesson in life but it will make you stronger if you get thru it
#36

karphead posted:

self-realizing how fragile the mind is a harsh lesson in life but it will make you stronger if you get thru it


not magically though. getting stronger still takes work.

#37

Petrol posted:

karphead posted:

self-realizing how fragile the mind is a harsh lesson in life but it will make you stronger if you get thru it

not magically though. getting stronger still takes work.



you're nuts

#38

Petrol posted:

karphead posted:

self-realizing how fragile the mind is a harsh lesson in life but it will make you stronger if you get thru it

not magically though. getting stronger still takes work.



it also take time which is what i was stressing as the focal point for all of those younger than me, which is all of you

#39
space, time
#40
fwiw (not much) i don't think you're older than me. anyway i wasn't disagreeing just making a separate point relevant to those like myself for whom time alone is not enough - that it's not a defect, just a bit more work is required to get where you want to be.