Draft Radiolab Pitch

 


Two decades after almost killing himself, 46 year old Francesco Bellafante is seated on a dais fifteen feet away from Dr. David Shulkin, the Secretary of Veteran Affairs, and 600 other leaders from the VA.  He was invited to address the group at their Senior Leader Annual Business Meeting by Dr. Tracy Gaudet, the Executive Director of the Office of Patient-Centered Care and Cultural Transformation at the VHA.  She and her team are working to transform how the VHA delivers healthcare, and she thought putting the person who wrote: Mental Illness’ is a Harmfully Misleading Phrase That Causes Suffering by Design in front of the top brass of the VA could help.

Five years after graduating Magna Cum Laude, Phi Beta Kappa from Notre Dame, Francesco was the youngest Principal at a Wall Street IT consulting firm.  Several weeks after seeing Good Will Hunting, Francesco was found unconscious, with a large bump on his head, inside of a running rental car that he’d transformed into a makeshift gas chamber.  Francesco had a near death experience in the ambulance enroute to the Jersey City Medical center, and woke up a couple of days later in the ICU.      

The former Wall Street quality assurance analyst is on a mission to: “change the world by changing the words that people use about ‘mental illness’” in service of halving the US suicide rate. Francesco’s 20+ year journey from suicidal near death experience to addressing a member of President Trump’s cabinet includes two visits to mental hospitals, two unauthorized visits to CIA headquarters, and a courtroom mini-drama orchestrated by someone committed to lampooning an improvable healthcare system.

Francesco believes that the “brand new greatest story ever told” that almost everyone is familiar with, but doesn’t understand, is about a man named Albert Einstein, @thedigitaljesus of our time, who left humanity an Unheralded Prescription for Peace.

What if Stephen Paddock was a suicide prevention advocate?

Suppose, for a moment, that Stephen Paddock, the man responsible for the massacre in Las Vegas, was a suicidal suicide prevention activist, committed to transforming the gun debate.  Imagine if what you see below was his suicide note.

Any reasonable person who spends even a modicum of effort to try to develop a plan to reduce the number of Americans who die every year from gun violence would focus on preventing suicides by firearm.

Even a child in grade school, given a handful of statistics, can quickly surmise that the people in power in Washington are more focused on remaining in power, and enriching themselves financially, than reducing the number of people who die by suicide by gun. What I have done here in Las Vegas was aimed at highlighting the facts that I just pointed out.

I predict that media organizations in this country will repeatedly play video recordings of the terrifying fish-in-a-barrel massacre that I just perpetrated.  They will sensationalize the horror I rained down on the unlucky people caught up in my plan to make a meaningful difference in this world before I die.  Details about the modifications made to the weapons I intend to use will be seized upon, and may even inspire talk from some pols about banning such devices.  When they do, be sure to ask them, “How many of the 60 Americans who die by suicide by firearm, every single day in the U.S., kill themselves with a semi-automatic weapon that’s been legally modified to an automatic one?”

Make no mistake, this country’s problem isn’t gun control, it’s the love of profit over life.

Truth be told, I am suicidal.  Why I feel this way is unimportant, but what is important to me is that people understand why I did what I did.

My dying wish is to transform the way the people in this country frame the gun control problem.  May the lives lost in this massacre not be lost in vain.  Let this event and these words be the one to inspire Americans to finally begin to realize that for-profit media concerns and self-interested politicians are the puppet masters pulling the strings of an all too amenable public.  Americans must never forget that they live in the capital of capitalism.

As terrifying as mass murder massacres undoubtedly are, the loss of lives as a result of them, pales in comparison to the number of people who die by suicide.  About 120 Americans die by suicide every single day in this country, and about half of those are suicides by firearm.  Refuse to be distracted by the sensationalistic news coverage.  Refuse to let politicians and for-profit media companies focus the gun control debate on these relatively rare events that claim so few lives compared to suicide.

Stephen Paddock
Suicide Prevention Advocate

Do you think a revelation like this would make any difference in the gun control debate?

Championing transformational change at the VHA and The Mighty

Dr. Tracy Gaudet

Dr. Tracy Gaudet is the Executive Director of the Office of Patient-Centered Care and Cultural Transformation at the Veterans Health Administration, and she is the person who invited me to participate in a plenary panel discussion about how her team’s Whole Health Model is helping to re-conceptualize healthcare within the VHA by focusing on what matters most to the veterans rather than what is the matter with them.   This transformational approach to care delivery aims to improve the experience and well-being of veterans receiving healthcare services.  

Dr. David Shulkin

Our panel addressed the Secretary, and 600 other senior leaders from the VA, assembled for their annual leadership summit Monday and Tuesday of last week.  It was an honor and a pleasure to share the dais with the veterans, and to contrast my journey through the civilian mental healthcare system two decades ago, while in the midst of a suicidal crisis, with the stories of veterans experiencing care based on the Whole Health Model.  I was grateful for the opportunity to provide my insights to such an influential audience in service of helping veterans struggling with suicidal impulses.

photo credit: Eugene Russell, VA Photographer

A dear friend introduced me to Dr. Tracy Gaudet and her team’s unconventional approach for providing integrative, proactive, whole person-centered care to our nation’s veterans a couple of years ago.  Reading a document that describes their Whole Health Model, and how it could help with the fight to reduce suicide, changed the course of my life.

I had all but given up on working to be an agent of change committed to reforming our current healthcare system, but learning about her team’s approach to helping people maximize their well-being gave me hope that change was possible.  I was inspired, and within a year, I had left my full-time position as a project leader in  information technology to focus on suicide awareness and prevention and mental healthcare reform.  I became a board member of the Philadelphia chapter of the American Foundation for Suicide Prevention, and a Zero Suicide Champion for the Suicide Prevention Resource Center’s life-saving paradigm for helping care providers vitalize their suicide prevention regime.

My journey through a mental healthcare system that had placed my care provider and my problems at its center, revealed obvious opportunities for improvement.  The Whole Health approach places the healthcare consumer at the center of the care delivery model, and champions proactive measures to promote and sustain health and well-being, rather than reactive ones aimed at managing the symptoms of a malady.  You can read more about how Dr. Gaudet and her team are driving cultural transformation within the VHA via “well-being innovation” in her own words here,  and you can watch the entire Whole Health panel presentation from last Tuesday morning here.  I believe Dr. Gaudet included me on the panel, in part, because of my public criticism of the mental healthcare system that treated me subsequent to nearly dying by suicide two decades ago.  [“Mental Illness” is a Harmfully Misleading Phrase that Causes Suffering By Design ] It’s hard for me to express how grateful I am to have had the opportunity to share such unconventional ideas with such a powerful and influential audience.  

I am always grateful when people in positions of power enable me to reach an audience.  I was grateful when Michael Kasdan shared my writing with The Good Men Project audience.  I was grateful, and honored, when someone at Mad in America was compelled to share my writing with their readership.

 

Weeks before I shared some of my status quo-challenging ideas about mental healthcare with Secretary Shulkin and the senior leadership of the VA, I submitted a slightly modified version of the aforementioned article to The Mighty – a for profit media company aiming to help people “face disability, disease and mental illness together.”  They declined to publish the article.

In May of this year, I co-wrote an interview article entitled What is mental illness? with author and Guggenheim Fellow Christopher Lane, who wrote Shyness: How Normal Behavior Became a Sickness a decade ago. You can read an excerpt from that piece on my blog here.  I was in contact with an editor from The Mighty about the article via email while Chris and I were writing it.  I sent the editor a draft of the piece during the first week of June, and I have never heard back from her since.  I attempted to connect with her publicly about the article on Twitter, where we have communicated in the past, but she remains unresponsive.

I suspected that the reasonable criticisms of the biomedical narrative of “mental illness” throughout our What is mental illness? piece might not be well-received by The Mighty.  Reading article after article, on TheMighty, written by well-meaning, but arguably misguided advocates touting the validity of the biomedical narrative of “mental illness” convinced me that the media company’s leadership may be positioning themselves to profit from advertising psych meds to suffering people.  It concerns me that more people may be misled, like I was twenty year ago, to believe that their suffering necessarily stems from an impossible to pinpoint disease of the brain that is certainly responsible for their suffering.

It’s hard to believe how lucrative simply marketing pharmaceutical medications to people in psychological and emotional distress has become in this country.  The thriving multi-billion dollar direct to consumer (DTC) psych med advertising business increased almost 10% in 2016 to $5.6 Billion according to data from Nielsen, and that figure doesn’t even include money spent on digital advertising.  The impact of this reductionist narrative propagated by the manufacturers of psych meds is evident in many stories you’ll find on The Mighty.  Article contributors prone to blaming or scapegoating their ostensibly malfunctioning brains for their suffering are commonplace.  In fact, particularly eloquent advocates are celebrated and awarded for their activism.

Unfortunately, more often than not, stories published by The Mighty downplay, or completely ignore, evidence pointing to the complex interplay of biological, psychological and environmental factors that lead people to experience the symptoms commonly associated with the condition descriptions found within the American Psychiatric Association’s bible, the Diagnostic and Statistical Manual of Mental Disorders.  Sadly, it’s not hard to find evidence that giving people powerful psychoactive drugs often serves to increase people’s suffering in many cases.  See the chart above for billions of reasons why suffering people continue to pay for treatments that may harm them instead of help them.

I don’t know why the editorial staff who work for Megan Griffo, The Mighty’s editor-in-chief, were not inclined to publish the two aforementioned articles that I submitted, but I stumbled upon a Mad in America post by Twilah Hiari yesterday that may offer some insight.

Her account of a comment made by The Mighty’s Chief Revenue Officer confirmed that my suspicion about The Mighty’s strategy to profit from advertising psych meds may be accurate:
The Mighty’s Chief Revenue Officer’s comment reminds me of one made by a world renowned panic and anxiety expert, Isaac Marks, when he was telling Christopher Lane about a conference he attended in connection with the DSM-III task force he served on back in the 1970s.  Marks shared a recollection with Lane about a comment made by the CEO of Upjohn Pharmaceuticals.  He was discussing the potential inclusion of new disorders in the DSM when he said:
There are​ three​ reasons​ ​why ​Upjohn​ ​​is​ ​here​ ​taking​ ​an​ ​interest​ in​ these​ diagnoses.​ The​ first​ is​​ money.​​  ​The​ ​second ​​is​ ​money.​ ​And​ ​the ​third​ is money.
Like Ms. Hiari I don’t question the good intentions of the people working at The Mighty, but I am afraid that until we transform the way many people apprehend the role that psychological and environmental factors play in various forms of human suffering, our mental health care system will continue to harm many of the people it aims to help.

An open letter to Vynamic CEO Dan Calista: fixing (mental) healthcare

Dear Dan:

I graduated from Archmere Academy in Claymont, Delaware, in 1989 with thirty AP credits, and then headed to Notre Dame.  After three and a half years in South Bend, I graduated Magna Cum Laude with a double major in English and Computer Applications in 1993.  I thought I was going to be a lawyer, eventually, but figured I would work for a while first, so I pursued opportunities in information technology.  I received job offers from Arthur Andersen Tax Technology Group in Chicago, Andersen Consulting in Philadelphia, Price Waterhouse in Washington, D.C. and Ernst & Young in New York City, but I accepted a position with The Travelers in Hartford primarily because their “ACCENT Program”  (accelerated entrance into management) was the hardest job offer to win.  Motivated primarily by the fact that I was “college-sick” after leaving my best friends back at Notre Dame after graduating early, I left The Travelers after just five weeks to become the Director of Information Systems at a fast growing restaurant chain in Delaware — Grotto Pizza.

Four years later in 1997, I was the youngest Principal consultant at American Management Systems’ 1 Chase Plaza office, located just a couple of blocks from Wall Street.  I spent most of ‘96 and part of ‘97 living and working in Zurich for Credit Suisse —  my B2B bill rate was $250 an hour.  Then, on the morning of March 2nd 1998, a warehouse manager in Secaucus, New Jersey, named Norman found me inside of a running rental car that I had turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the back of an ambulance, enroute to the Jersey City Medical Center, and I woke up a couple of days later in the ICU.

I’m writing to see if you’d be open to having a conversation with me about how we might work together to save lives and reduce suffering by helping to transform mental health care in this country.  I am already doing this work on a volunteer basis on a number of fronts.

I am a board member of the Philadelphia Chapter of the American Foundation for Suicide Prevention, who is working with John Madigan (AFSP VP of Public Policy) to leverage my relationship with Vice President Biden to garner political will for a massive increase in public funding for suicide prevention.  I was high school teammates with both of VP Biden’s sons at Archmere Academy.

I am a Zero Suicide champion working with Dr. Tracy Gaudet, the Executive Director of the National Office of Patient Centered Care and Cultural Transformation at the VHA.  I’m participating in Dr. Gaudet’s panel discussion on Whole Health and suicide prevention in the military in September at the VA’s National Leadership Conference.  Secretary Shulkin is committed to reducing the suicide rate at the VA, and he’s asked Dr. Gaudet to organize a panel of experts to address the VA leadership on the subject.  I’m also working with Dr. Gaudet and David Wright from GetWellNetwork to propagate the Zero Suicide framework via GetWellNetwork’s interactive patient care system.  The VHA already utilizes GetWellNetwork’s platform in over forty facilities. GetWellNetwork’s founder and CEO, Michael O’Neil, is one of my closest friends.  We met at Zahm Hall as freshman at Notre Dame in May of 1989.  

I’m in conversation with Keppler Speakers to begin giving talks nationally at universities and colleges before the end of the year with the aim of reducing the U.S. suicide rate.  Here is a video of me practicing the first half of the talk I will be presenting at my alma mater in South Bend.

As far as I can tell, I am the only person on Earth who is leveraging the genius of Albert Einstein to transform humanity’s understanding of the human condition and “mental illness.” I believe that Einstein left humanity an unheralded prescription for peace that almost no one noticed:  acknowledge that human beings don’t possess free will.  If I am ever invited to speak on the TED Talk stage, I suspect it will be because I am committed to spreading the ideas that I outlined in this piece on Medium.

My writing about suicide prevention and mental health care reform has been published by The Good Men Project and Mad in America, thus far.  Christopher Lane (Guggenheim Fellow and author of Shyness: How Normal Behavior Became A Sickness) and I are wrapping up an interview piece entitled “Creating ‘Mental Illness’” that looks back at a critical event in mental health care history at the center of his book Shyness:  the third revision of the APA’s Diagnostic and Statistical Manual of Mental Disorders or DSM-III.  A work in progress excerpt of that piece is included below.

The attached resume doesn’t include my current consulting engagement.  I was hired to  turnaround a failed client reporting enhancement project at one of the top 10 wealth management firms in the U.S. based on fiduciary assets.  My engagement sponsor is the C-level fixed income officer of the firm responsible for managing a $27 Billion portfolio.

I’ve known Scott O’Neil, CEO of the Philadelphia 76ers, the New Jersey Devils and the Prudential Center coming up on thirty years now.  Scott is Michael’s older brother, by one year, who was at Villanova while we were at Notre Dame.  We met in 1989 when Scott was visiting Michael in South Bend to watch a Notre Dame football game.  I mention this fact because Scott is connected to Mairead Hanna on LinkedIn. I haven’t touched base with Scott about this yet. I was compelled to reach out to you cold first.

If you’re open to having a conversation with me to determine if it makes sense for us to seriously consider joining forces in some way to save lives and go after the triple aim in HIT together, please just let me know.  I would greatly appreciate the opportunity to speak with you.

Thanks a lot for your time and consideration.

Sincerely,
Francesco

Francesco Bellafante
American Foundation for Suicide Prevention Philadelphia Chapter Board Member
Zero Suicide Champion
Theory of Mind ~ leveraging the genius of Einstein to end suicide and to maximize well-being
iameinstein.com

Excerpt from:

Creating “Mental Illness”

By Christopher Lane and Francesco Bellafante

How does someone know if they have a mental illness?  How does their doctor know?  Psychiatrists don’t utilize blood tests or brain scans to diagnose their patients.  Instead, they necessarily rely on subjective observations about how their patients seem.  That, plus they listen to stories told by their patients, and others, in order to identify symptoms of mental disorders.  Given our relative ignorance about how the most complex object in the known universe functions, how does a psychiatrist know that a particular feeling, behavior or pattern of thinking and behaving is a symptom of mental illness?

The human brain is made up of about 86 billion neurons that interact in complex ways with one another and with other neurons throughout the central nervous system.  Absolutely no one can cogently explain how a human being’s neurons interact with the rest of its body and the world that body inhabits to give rise to subjective, conscious awareness of that world. Consciousness remains an enduring mystery.  Given these facts, how does anyone objectively draw a dividing line between mental wellness and mental illness?  What amount, degree, or kind of neurosis, psychosis or distress is a natural part of the human condition? How do we know when a person’s behavior or their psychological and emotional state is indicative of psychopathology?

What is mental illness?  Is it a disease like any other resulting from a defective or malfunctioning organ or system of the body?  Or is mental illness too often a phrase used to mistakenly pathologize and stigmatize the human condition itself?

Two influential books that shape humanity’s understanding of what it means to be mentally ill are ones that most people have never heard of let alone ever read. They are the International Classification of Diseases and the American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders.  Hundreds of nuanced descriptions of different patterns of thinking, feeling and behaving define the bounds of what constitutes “mental illness” or “disorder” for billions of people.  While some question the inclusion of certain kinds of behavioral disorders within the pages of any catalogue of medical diseases, the stories told by psychiatrists citing the conditions defined in these nosologies are respected as scientifically-validated, unquestionable medical truths by many others, in large part thanks to billions of direct-to-consumer advertising dollars spent propagating this narrative.  Exceptionally effective professional storytelling tactics are employed by for profit enterprises marketing powerful mind altering substances to people experiencing anything from a lack of ease in life to paralyzing distress or despair.

I grant that attempting to assuage people’s distress and despair with psychopharmacological treatments may be well-intentioned, but evidence abounds that giving people powerful mind-altering drugs serves to increase people’s suffering in many cases.  In fact, some psych meds prescribed for mental disorders can cause death by inducing something called Neuroleptic Malignant Syndrome.  I was given an injection of Haldol once, without my consent, that could have induced this potentially fatal syndrome within me.  I am grateful I was not informed of the life-threatening nature of the “health care” I was receiving before I was involuntarily injected with a substance that could have killed me.  I share what I’ve learned about these books with the hope that more people will think more critically more often when they speak and write about “mental illness” and “mental disorders.”

The story behind how the ICD and the DSM came to include certain mental disorder descriptions is a fascinating one.  It was 1893 when the International Statistical Institute adopted the International List of Causes of Death.  By the end of 1949 the World Health Organization published the sixth edition of the International Classification of Diseases or ICD-6.  This version was the first to contain a section for mental disorders.  Three years later, in 1952, the American Psychiatric Association’s (APA) Committee on Nomenclature and Statistics published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  As the APA’s DSM History page on its website explains, “It contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical use. The use of the term ‘reaction’ throughout the DSM reflected the influence of Adolf Meyer’s psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors.”

(Source:  https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm)

Thirteen years later, in 1965, Sir Aubrey Lewis, a British psychiatrist responsible for the mental disorder section revisions of ICD-8 removed the word “reaction” from the mental disorder names.  This seemingly insignificant nominal change represented a seismic shift in defining mental illness. Christopher Lane from Northwestern University, a 2005 Guggenheim Fellow, wrote about this seminal event in Shyness:  How Normal Behavior Became a Sickness (Yale, 2007).

“The revisions to ICD-8 were bold, even cavalier, and had lasting consequences.  Consulting few outside experts, a situation unimaginable a generation later, the person appointed to update the manual quietly eliminated the term reaction from many diagnostic labels.  As a result, diagnoses like schizophrenic reaction, which in DSM-I had referred to sporadic psychiatric incidents, evolved almost overnight into schizophrenia, even if the person’s symptoms were rare or not especially violent.  The same was true for terms like paranoid reaction, which the DSM-II task force determined henceforth would be known simply as paranoia.  When I asked Robert Spitzer about these revisions, he confirmed my suspicions, ‘ICD-8 was written by one person, [Sir] Aubrey Lewis at the Maudsley [Institute of Psychiatry, London], and he didn’t have the word ‘reaction’ in the eighth edition, so DSM-II didn’t either. ‘No,’ Spitzer added, ‘there was no discussion at all’ on the  DSM-II task force about the viability or consequence of adopting these changes.  Turning phrases like ‘schizophrenic reaction’ into simple nouns (‘schizophrenia’) may seem insignificant.  But as Spitzer concedes, it was a ‘major shift’ in approach, because it altered at a stroke the very meaning of illness for clinicians and patients.

Robert Spitzer was a Professor of Psychiatry on the research faculty at Columbia University in New York City.  In 1974, he became the chair of the APA’s task force responsible for revising  DSM-III.  Spitzer played a major role in leading a faction of psychiatrists on the task force to significantly revise, and add to the number of disorders defined in the DSM-III, swelling the count of conditions contained in the growing catalogue by an eye-popping 46%.

Year          Edition            # of disorders             % growth

1952          DSM-I               106                                      n/a

1968          DSM-II             182                                      72%

1980          DSM-III           65                                        46%

It has been a decade since Lane penned his assiduously researched and insightful account about this transformation of the APA’s Diagnostic and Statistical Manual of Mental Disorders.  His penetrating explanation of how a small group of psychiatrists privately collaborated in the 1970s to revise the organizing document behind their profession is as amusing as it is unsettling.  The incredible but true tale Lane tells about how shyness came to be viewed as an illness is more akin to political farce than erudite debate about how to classify different types of mental disorders, ostensible or otherwise.  Lane gained unprecedented access to the APA’s archives, and found documents detailing disturbing facts about the lack of scientific rigor employed while revising the third edition of this influential document.  He frames this battle over this revision of psychiatry’s diagnostic bible as one driven by deeply-rooted internal conflicts within the field.  Neuropsychiatrists argued for the radical expansion of the diagnostic criteria into many different disorders with specific symptoms while their Freudian colleagues favored a psychodynamic approach with fewer, and more broadly defined categories that recognized the biological, psychological and environmental factors that coalesce into human distress and despair.  While neuropsychiatry clearly won this battle in the pages of DSM-III, Lane’s writing about the inner workings of Spitzer’s task force illuminate how a supposedly scientific process devolved into one guided more by individual personalities, professional agendas and profit potential.

Reflecting on the legacy of Robert Spitzer shortly after his passing in 2015, Lane wrote a post on his blog about a significant exchange between Spitzer and Isaac Marks, involving the inclusion of Panic Disorder in  DSM-III as a stand-alone illness.  Marks “the world-renowned expert on panic, fear and anxiety” was flatly against the inclusion of Panic Disorder as a separate illness.  From Lane’s blog post:

“Though committed to treating and understanding panic, Marks was steadfastly opposed to its being represented as a stand-alone disorder. He was similarly opposed to the formal identification of Social Phobia/Social Anxiety Disorder as a separate disorder, not least after seeing his own research on the subject (pointing to a different conclusion) cited as a reason for the change. The evidence that Social Phobia should be separated off had not been overwhelming and little had been published since that implied otherwise. But on both counts, Marks was overruled. ‘The consensus was arranged by leaving out the dissenters,’ he said to me ruefully, after Spitzer had told him in the men’s room at that key Boston conference that he ‘wasn’t going to win. Panic [disorder] is in. That’s it.’ ‘Never mind about the pros and cons intellectually,’ Marks continued, characterizing Spitzer’s apparently cavalier rejection of his expertise and objections. “Don’t confuse me with the data. It’s in.”

The Boston conference had been paid for by Upjohn Pharmaceuticals, maker of Xanax, a drug that became widely prescribed for Panic Disorder. As the CEO stood up to give his opening remarks, Marks recalled, he admitted quite openly: ‘There are three reasons why Upjohn is here taking an interest in these diagnoses. The first is money. The second is money. And the third is money.’ Despite concern that his research was being misused, to ends he could not support, Marks was, he said, ‘disinvited’ from subsequent discussions. Panic Disorder and Social Phobia/Social Anxiety Disorder weren’t just included in DSM-III, but, as he feared, given such low diagnostic thresholds (including, in 1987, public-speaking anxiety for SAD) that millions of American adults and children became eligible for a diagnosis, with Xanax, Paxil, and other medication among the most frequently prescribed treatments.

After the fact reflections of people involved in the DSM-III task force reinforce the notion that the conditions described by the disorder names defined within the pages of any version of the DSM are certainly unlike other diseases and illnesses that plague humankind in obvious and important ways.  “There was very little systematic research [involved], and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest,” said a consultant on the revision task force.  Others involved commented that, “The poverty of thought that went into the decision-making was frightening… In some cases, the people revising DSM-III [were] making a mental illness out of adaptive behavior.”  In 1984, four years after DSM-III’s publication, psychiatrist George Valliant warned that the “disadvantages of DSM-III outweigh its advantages,” characterizing the revision as one that “represents a bold series of choices based on guess, taste, prejudice, and hope.”

Maybe “mental illness” isn’t what you think it is…

A different version of this post was published by The Good Men Project where it has been shared almost 400 times so far.  Subsequently, this article was republished by Mad in America where it has been viewed over 1100 times.  I recently submitted it to The Mighty.  I received an email from them explaining why they would not be publishing it which included the line below.

Right now, we unfortunately don’t have the capacity to publish every story on our site.

I sincerely doubt “capacity” had anything to do with The Mighty’s editorial decision regarding this piece.

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 so far 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.  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 accurate 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 to decrease the likelihood that other people won’t be misled like I was.  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 nearly killed myself 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 an antidepressant 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 almost killing myself.  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 medication I was taking 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 lack of ease 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.  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.  Cognitive behavioral therapy is an effective way to address these often disempowering ways of thinking.  This other narrative that describes the conditions and events that led to my psychological and emotional struggle is patently more accurate and more practically useful than anything my psychiatrist told me about my ostensibly malfunctioning brain.  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 an antidepressant.  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 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.

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.  While reviewing my bill, after being released, I noticed that I was billed for “Individual psychotherapy” five times, one charge for each day of my stay. 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 taking an antidepressant. I’m aware this fact doesn’t prove that the antidepressant was the proximate cause of this development in my life, but given the wealth of evidence supporting the hypothesis that antidepressants 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.

I’m so grateful that someone was willing and able to inspire me to question the stories psychiatrists told me 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 psych meds going to their pay bills?  Ironically and probably unbeknownst to the vast majority of people diagnosed with a “mental illness” the National Institute of Mental Health ceased funding research based on the categories listed in the DSM in 2013.  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 people don’t experience emotional distress.  I’m arguing that the words used to describe the causes of feeling a lack of ease or distress can perpetuate a person’s lack or ease, or worse, compound it.  I am committed to changing the world by changing the words that people use when they talk about “mental illness.”

Here’s an example:

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.

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.

Which is more empowering?

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 job he loves, 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.  Shocked by the revelation, his family said 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.

Is building the Golden Gate Bridge suicide deterrent net a myopic misappropriation of money?

If you are part of the suicide prevention movement, you are likely aware of the fact that work to attach a suicide deterrent system to the Golden Gate Bridge commenced recently.  While reading the piece about this seminal event by Samantha Schmidt published in the Washington Post, I found the exchange pictured below in the comments online.

 I replied to “Kompromat” as follows:

I’ll grant that the claim about finding other means to die by suicide is contradicted by empirical evidence, but I’m curious what scientific studies you’re referring to regarding the other two claims. More than 1500 Americans die every single month due to suicide via a firearm – a death toll of over 1.7 million lives lost over 80 years. Claiming that $200 million is “too high a price” to pay to save hundreds of people from dying by suicide, when thousands or tens of thousands of lives might be saved if this money was directed to firearms means restriction programs seems like a reasonable claim. Unfortunately so too is the claim about life being too painful for too many people to endure.

If/when a suicide occurs at the Golden Gate Bridge after the net is completed, it will surely be the most sensationalized suicide in US history, won’t it? This event, if/when it occurs will also be the most demoralizing, and most costly, financially speaking, for the suicide prevention movement, I imagine.

I think spending over $200 million dollars on this net sets the stage for a suicide prevention movement calamity. The net will be 20 feet below the bridge, right? Imagine a suicidal person at the ceremony commemorating the net’s completion. Imagine this person has a ten foot metal cable concealed under her clothing. One end of the cable has a fastener capable of being quickly attached to the bridge’s railing, the other end is looped around her neck.

Surely, the installation of the net at the Golden Gate Bridge increases the chances of a horrifically tragic event like this happening. The only reasonable reason to spend over $200 million on this project is to create a suicide means restriction symbol.

It seems reasonable to claim that given:

1. the fungibility of money,
2. the relatively minuscule number of lives lost to suicide at the bridge versus suicide by firearms nationally (58 every single day) and
3. the patent increase in the likelihood of the most sensationalized suicide ever, occurring at the bridge, to ill-effect to the cause of reducing the suicide rate…

that a suicide prevention investment of this magnitude for this purpose is so myopic that it’s a moronic misappropriation of money.

Make no mistake, if I could snap my fingers, and cause suicide deterrent systems like the one being built at the Golden Gate Bridge to magically exist under every single bridge on Earth where a suicide has occurred, I would.

That said, surely a life lost to suicide at the Golden Gate Bridge is not more valuable than any other life lost to suicide, right?  In the work of stopping suicide, it’s an absolute value numbers game, isn’t it?

The resources at our collective disposal to prevent suicide are scarce.  For example, The American Foundation for Suicide Prevention, the largest private national non-profit involved in the fight to stop suicide has an annual budget that’s only about $18 Million.  The AFSP is going after reducing the suicide rate in a strategic way to make the best use of the limited financial resources it has at its disposal.  They have a practical plan to reduce the U.S. suicide rate by 20% by 2025.  A primary focus in that plan is to aggressively address lethal means restriction as a way to save lives.  The most common way to die by suicide in this country is by firearm, and the AFSP has recently started working directly with the National Shooting Sports Foundation.  Their collaboration has led to a breakthrough firearms lethal means restriction program.

The AFSP is working with representatives from local gun shops, shooting ranges and hunting clubs to educate retailers and the firearm-owning community on suicide prevention and firearms.  The pilot program, involving community-based AFSP chapters in four states, is the first time a national suicide organization has collaborated with gun retailers, range owners and the firearm-owning community about suicide prevention and firearms.  Many of the strategies of the pilot program will utilize co-developed resources through a new partnership between AFSP and the National Shooting Sports Foundation, the trade association for the firearms industry.  “One of the first areas identified through Project 2025, our initiative aimed at reducing the annual suicide rate 20 percent by 2025, was a critical need to reduce the number of suicides using a firearm. But, we know we can’t do it alone,” said AFSP CEO Robert Gebbia. We will work alongside firearm retailers and range owners and the firearm-owning community to better inform and educate them on warning signs, and what to do if someone may be at risk for suicide.”

I will stipulate that there is a non-zero chance that if the suicide deterrent system at the Golden Gate Bridge is completed that not one single human being will ever again die by suicide at or on the bridge or the net.  That said, given my personal experience with suicidal thoughts and behavior, as well as my experience with other extreme states of highly creative consciousness, I doubt that the net will be the end of suicide at the Golden Gate Bridge.  It would surprise me if the completion of the net is not followed by a suicide at the bridge, assuming that its completion is not marked and forever marred by one.

Dying by suicide by jumping off of the Golden Gate Bridge is one of the most predictably sensational ways to die by suicide on Earth.  Investing in a suicide deterrent system with a price tag of $204,000,000 is a sensational way to deal with a sensational problem.  Not seriously considering how such a sensational act may presage the most sensational suicide of all time seems myopic to me.

I call on all of my brothers and sisters in this movement to save lives to consider thinking more critically and analytically about how we apportion the scant financial resources we have at our disposal to cause the suicide rate to go down as quickly as possible.

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