Responding to Rudy Caseres “I Have Bipolar Disorder – This is What Manic Means to Me” video

In 2002 a psychiatrist unjustly stripped me of my liberty and the right to pursue happiness because I fit a description of a type of “episode” (manic) listed in the DSM, eleven years before the NIMH abandoned research oriented on the nosology.  I don’t argue that I did not exhibit some behaviors that matched some of the diagnostic criteria for mania as described in the DSM. That said, it’s a fact that my doctor patently mistreated me by claiming that I had delusions without ever asking me a single question related to my ostensible false beliefs guiding my presumed to be utterly unreasonable behavior (trespassing at the CIA with weed and a big poster of Albert Einstein with his tongue sticking out).

I recently wrote an open letter to the doctor that used the “Bipolar Disorder” “mental disorder” story as a justification for why I was in need of emergency psychiatric care.
Here’s an excerpt of the letter:
 

You necessarily took action to have the police waiting outside your office prior to your examination of me, and to this day, you and I have still never exchanged a single word about my unauthorized visit to CIA headquarters in 2002.  Four federal CIA police officers and a staffer from the CIA questioned me for about three hours with a degree of professionalism that still blows my mind, especially considering that I pulled this stunt just forty-one days before the first anniversary of the 9/11 attacks.  It’s worth pointing out that these men, despite the fact that I was in possession of a controlled substance when I illegally trespassed at the CIA, decided to release me on my own recognizance versus throw me into a jail cell for the night, pending arraignment.  Things played out the way they did for me at the CIA because the people there that I spoke with were open to hearing a reasonable explanation for my actions… which is precisely what they received from me… and precisely why they let me go.  

committal documentYou and Dr. Ekong on the other hand, were patently not open to even attempting to reason with me. You failed to give me a chance to explain my actions before stripping me of my liberty, and she treated me with a potentially life-threatening medication before ever meeting or speaking with me.  It is clear to me, as I am confident that it will be to many others, that the forces of institutional corruption in psychiatry were at work in your respective decisions.  The knowledge that you had about what happened at the CIA was the by-product of a five-person game of Telephone or Whisper Down the Lane.  I told my father some of what happened that day, without much explanation as to why at all.  My father told my mother.  My mother told my brother.  And then my afraid-for-the-life-of-her-son mother told you.  You did what you did, and then Dr. Ekong became Telephone/Whisper Down the Lane player number six. The assumptions that you both necessarily made about me are gross examples of professional misconduct.

While you were very sympathetic about the anxiety experienced by your patient’s mother, you failed to even try to understand me, your patient, whom I believe you assumed was psychotic.  The fact that I was exhibiting some of the symptoms of a “mental disorder” described in the Diagnostic and Statistical Manual of Mental Disorders—a nosology disavowed in 2013 by Dr. Thomas Insel, the former Director of the National Institute of Mental Health—is a pathetically inadequate justification for involuntarily subjecting me to forced care that could have ended my life.

You can read the whole letter here.

I applaud and champion your activism Rudy. You’re an inspiration.
 
That doesn’t stop me from thinking it’s reasonable to consider that continuing to use the “mental disorder” condition names themselves from the DSM without any qualification or mention of the fact that the NIMH no longer researches “mental illnesses” as described by the nosology, lacks nuance and depth.
 
Finding yourself in a “mental disorder” storybook and championing the notion that you necessarily have been or are sick, ill, diseased, etc. may be helping to perpetuate the ostensibly intractable problem of the stigma surrounding “mental illness.” Using the nosology’s “mental disorder” names without qualification or clarification certainly perpetuates the “mental illness” diagnostic narrative of non-normative human behavior to ill-effect for many people.

“Mental Illness” is a harmfully misleading phrase that causes suffering by design

I’ve spent close to twenty years looking for reasons behind why I was compelled to think and act suicidally when I was twenty seven years old.  While my search has yielded more questions than definitive answers thus far, I’m convinced that sharing what I’ve learned will help others.

Events happen, and then people think and say things about those events—let’s call those stories.  No matter how accurate or truthful a story is seen to be, events that have occurred and the stories that people tell about those events, are never the same thing.  They can’t be because one is an occurrence in reality while it’s happening, and the other is an after the fact symbolic representation meant to describe a prior real occurrence.  I’m no linguist, but this is the nature of language, right?  We use language and stories to encapsulate and communicate meaning about our reality and our conscious experience of that reality—every word is a story unto itself making sense of existence.  Every diagnosis of every “mental disorder” relies on a translation of stories.  A person tells a psychiatrist a story, and the psychiatrist maps that natural language story onto a “mental disorder” language story from a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Millions of people assigned a “mental disorder” story or a “mental illness” diagnosis end up failing to see the basic event-story distinction I just pointed out.  They confuse their DSM diagnosis or “mental disorder story” with reality itself.  If you don’t believe me visit TheMighty.com, click on “Mental Illness” and start reading.  Unfortunately, many patients are also systematically misled to necessarily attribute the issue that prompted them to see a psychiatrist to a supposed specific brain pathology that mysteriously eludes specific definition and explanation.  

I made these mistakes after nearly killing myself nineteen years ago, in part, because of the forces of institutional corruption at work within our mental health care system written about by Robert Whitaker and Lisa Cosgrove in Psychiatry Under the Influence.  I share this true story as an anecdotal example of those corrupting forces in action.  It is my hope that others won’t make the avoidable cognitive mistakes that I made during my treatment.  I also hope to inspire the many well-intentioned but misguided “lived experience” mental health advocates who are confused like I was to think differently.  They are unwitting participants in this harmful confusion’s perpetuation.  

A few days after I unintentionally fell asleep inside of a car that I had intentionally turned into a makeshift gas chamber, a psychiatrist told me that I was suffering from a “mental illness” called Major Depressive Disorder after talking with me for less than fifteen minutes.  That’s all the time it took him to gather enough information to know which “mental illness” was plaguing me and how to treat it.  He prescribed me a medication called Paxil as he mentioned something vague about the amount of a neurotransmitter in my brain called serotonin and selective reuptake inhibition.  I also began seeing a psychologist for talk therapy twice a week.  In just three or four months I was feeling like my old self again—the same amount of time it had taken me to go from feeling fine to putting myself in that rigged car.  I believed the story my psychiatrist told me about the cause of my despair.  He gave me the name of an apparent disorder with my brain, and a pill to fix the problem.  Back then, it seemed to me that the Paxil did more to help me than anything the psychologist and I discussed.  That assumption was a costly one for me, and my family.  

It led me to make two consequential mistakes that millions of other people diagnosed with a “mental illness” also make.  First, I failed to see my diagnosis as a view of reality, mistaking it for reality itself.  I conflated a series of actual events from my life with a boilerplate story about a “mental disorder” from a big book.  Doctors are trusted authorities.  When you’re unquestionably hurting, it’s comforting when a trusted authority gives you an officially-sanctioned medical reason for why you feel so horrible, and better yet, a remedy to help you.  My mistake was compounded when I came to believe that my diagnosis mapped onto a specific brain pathology necessarily responsible for my problematic thoughts, feelings and behaviors.  My doctor gave no serious consideration to any psychological, social or environmental factors that contributed to the mindset from which my suicidal behavior emerged.  He couldn’t have—he didn’t know enough about any of those factors.  It is no surprise that I blamed my brain for my problems, like millions of other “mental patients” do.  Our collective confusion about a specific brain pathology necessarily being the sole or at least primary causal culpability for our problems is proof of the influence of the forces of institutional corruption within the mental health care system.  

A deeper examination of my suicidal crisis subsequent to receiving my “mental illness” diagnosis revealed how childish, fearful, egocentric thinking and bad luck led me down a path towards self-destruction.  To clarify “egocentric” I’m not talking about arrogance, narcissism or even self-preoccupation.  At the heart of my egocentrism in my younger years was the failure to readily recognize that my view of reality, was a point of view at all.  Growing up I prided myself on being right.  I prided myself on objective, quantitative measures of just how right I was.  I was especially proud when I was deemed 100% right.  Egocentric people become attached to being right, and they often are.  I became so accustomed to being right, that I confused my view of reality with reality itself.  I almost killed myself, in part, because of this confusion, this conflation of what I thought was happening with what was actually happening.  Sounds familiar, right?  There were four other types of childish and/or fearful thinking that led me from being involved in an awkward exchange during a routine business meeting in Toronto to genuinely believing that I was an unintelligent, overcompensated fraud of a human being destined to disappoint my father and myself.  Those types of thinking are called catastrophizing, overgeneralizing, black and white thinking and past counter-example blocking.  Any cognitive behavioral therapy resource of value will explain each of these in detail.  This explanation of the factors that led to my psychological and emotional struggle is patently more accurate and more practically useful than anything my psychiatrist told me.

Nineteen years later, it’s evident that me believing that my suicidal behavior necessarily resulted from a “mental illness” was more beneficial to the psychiatrist who told me that than it was for me.  I’m not claiming that this was a fault of my doctor or a sign of bad faith or ill-intent on his part.  His profession trained him to look for different nails to hit with different hammers, and I was a perfect fit for a hit from Paxil.  He was just doing his job—playing his role in a system.  Unfortunately, like millions of other people who are given a “mental illness” diagnosis, I came to see my diagnosis as a defining part of my identity (only temporarily fortunately for me!) because of my respect for my doctor’s authority, and my belief that my problem was necessarily in my brain.  This belief led me to seriously entertain the fallacy that I was biologically destined to suffer from despair over and over again.  I’m so grateful that someone was willing and able to inspire me to question my psychiatrist’s story about the cause of my suffering.  Powerful authority figures implying that brain pathology is necessarily to blame for the suffering behind “mental illnesses” increases the chances of people believing that they need to buy pharmaceutical remedies to be well.  How else are psychiatrists who only prescribe meds going to their pay bills?  Ironically and probably unbeknownst to the vast majority of people diagnosed with a “mental illness” the DSM itself, the book that contains the rules governing their diagnosis, was disavowed as invalid by the Director of the National Institute of Mental Health four years ago.  When announcing that no more federal dollars would be spent on research based on the DSM going forward, Dr. Thomas Insel said that diagnosing a “mental illness” by asking a patient about her feelings was analogous to diagnosing a heart patient by asking her about her chest pain.  I’m not arguing that “mental illness” does not exist, and in defense of the DSM, I will grant that it explicitly states that the causes of “mental disorders” are believed to be biological, psychological and social or environmental.   My argument is that the words used to describe a problem, and the assumptions those words imply, by definition, can be a causal factor in the problem continuing to exist, or worse yet, new problems arising.  This is clearly the case with the term “mental illness.”  

President Trump continually reminds us of the importance of the language we use to describe problems, and how some language helps perpetuate problems and create new ones.  I am committed to changing the world by changing the words that people use when they talk about “mental illness.”

Here’s an example:

BEFORE

You have a “mental illness” or a “mental defect” resulting from a specific, yet somehow unidentifiable, brain pathology that is causing you psychological and emotional distress.  You can treat your “mental disorder” with a chemical made in a lab that will hopefully mysteriously correct your brain pathology for as long as you can bear the undesirable effects of that chemical.

AFTER

Learning more about yourself, the human condition and the many different approaches proven to help other people maximize their own well-being will help you to grow into a person who experiences less and less psychological and emotional distress over time.

 

If I still haven’t convinced you, please consider this final example from history that hopefully more clearly illustrates my point that a “mental disorder” or a “mental illness” diagnosis is necessarily a subjective story about events, and not an objective description of a constellation of thoughts and behaviors that are necessarily caused by a specific brain pathology.

Imagine it’s 1972 and a man visits a psychiatrist because despite having a great relationship with his lover and a great job, he’s miserable.  He’s been estranged from his entire family, and he is suffering a great deal as a result.  He can’t sleep.  He’s constantly anxious, and he’s feeling quite hopeless about things ever getting better.  He explains that all of his problems arose when he admitted to his family, a few weeks ago, that his lover was a man.  His family said that they never wanted to see or speak with him again.  The doctor tells the man that the source of his problem is a “mental disorder” in the DSM called Homosexuality.  The man is the son of a southern Baptist minister, and he has been ashamed of his attraction to men his whole life.  He respects his doctor, and his father too.  In fact, he thinks they’re both right.  He sees his love and sexual desire for men as sinful urges that he is supposed to resist, but he is incapable of doing so.  He sees his homosexual acts as mortal sins, and evidence of brain pathology. Feeling utterly hopeless, lost and beyond redemption, a month after being diagnosed with the Homosexuality “mental disorder” the man kills himself.

Please consider helping me spread the idea that “mental illness” is a harmfully misleading phrase that causes suffering by design.

3/9/2017 Update

Evidence supporting the claim that my belief that I had a brain disease in need of pharmaceutical treatment was more beneficial to my psychiatrist:

My stay at the private mental hospital subsequent to nearly dying by suicide was five days long.  I spoke with my psychiatrist on three separate occasions during my five day stay.  We spoke briefly on the day I was admitted.  We bumped into each other once, and spoke for less than five minutes.  And we spoke for about ten minutes on the day I was discharged, and went home.  While reviewing my bill, after being discharged, I noticed that I was billed for “Individual psychotherapy” five times, one charge for each day of my stay.  If memory serves, the charge was $125.  When I called the mental hospital to inform them of the obvious billing error, I was informed that every patient in the facility was charged in this manner.  I explained how this seemed patently fraudulent and unethical to me given the literal definition of the word psychotherapy.  The person I spoke with apologized but said there was nothing she could do, remarking something like, “That’s just how it works.”

The first time I thought and behaved in a way that matched the diagnostic criteria for a “manic episode” found in the DSM occurred after I ingested Paxil.  I’m aware this fact doesn’t prove that the Paxil was the proximate cause of this development in my life, but given the wealth of evidence supporting the hypothesis that anti-depressants like Paxil often have iatrogenic effects on the people who take them, like inducing mania, for example, it’s reasonable to consider that my treatment for Major Depressive Disorder was a causal factor in me exhibiting behavior that led a different psychiatrist to diagnose me with Bipolar Disorder I.

Einstein thought shame arose from a gross misunderstanding of the human condition

Kevin Hines is a suicide attempt survivor whose efforts to try to help people struggling with self-destructive thoughts and behavior have inspired me.  He recently posted a video on Facebook about his #mysevenbucksmoment in response to Dwayne “The Rock” Johnson.  In his video Kevin talks about the shame he felt after his suicide attempt.  As a fellow suicide attempt survivor, I’m familiar with how people who live through suicidal behavior feel guilt, embarrassment and shame as a result.  I was watching the final moments of the Obama presidency draw to a close after watching Kevin’s video, and I was inspired to share the following thoughts with him.

Regarding the shame you mentioned…

Albert Einstein (and many other thinkers) believed that emotions of shame and guilt arise from a gross misunderstanding of the human condition. Einstein said that a belief in free will results from a “delusion of consciousness.” There is a growing pile of evidence being amassed by scientists to back this claim up.

I’m compelled to suggest that Albert Einstein’s free will skepticism–his belief that a person is mistaken in thinking that he or she could have done other than he or she did–is an unheralded prescription for peace that this insightful genius left for the benefit of humanity.

I’m compelled to champion this idea within the suicide prevention community. We have GPS technology and many other modern marvels because of Einstein’s genius insights about reality. It’s time to consider leveraging Einstein’s apparent genius insight into the human condition too.

A world full of people who genuinely view free will as an illusion, and who are committed to maximizing well-being is a world without shame. It’s a world without egotistical pride. It’s a world without revenge–a world without hate of self or others. It’s a world full of people being compassionate, loving and grateful.

Recognizing that we may have already extracted as much utility from the likely fictional idea that human beings are autonomous agents consciously controlling their thoughts, feelings, and actions and therefore their lives, is an important conversation that I don’t hear many people in suicide prevention and mental health advocacy having. I’m committed to changing that reality. Recognizing the likelihood that free will is an illusionary creation of humanity is a silver bullet capable of piercing the heart of the stigma surrounding “mental illness.”

It’s evident to me that Einstein would have said that believing in free will is a major risk factor for depression and becoming suicidal. The Buddha would agree as would Nietzsche. So too would neuroscientist Sam Harris and professors Bruce M. Hood, Thomas Metzinger and Thalia Wheatley.

It’s time to seriously consider Einstein’s conception of what it means to be a human being. This guy was clever enough to notice that humanity was grossly misperceiving the foundational building blocks of our reality–time and space. Is it so incredible to fathom that Einstein might have had profound insights into the illusory nature of the “self” and free will worthy of our attention and consideration?

Einstein’s conception of what a human being is and how reality works would suggest that we reconsider how we approach describing the problem of human suffering, including the suffering that leads people to die by suicide.

Looking forward to talking to you.

Best,
Francesco