what it’s for…

Posted on Friday 7 November 2014

Back in the 1980s when psychiatry [and psychoanalysis, and medicine, and American culture] was undergoing big changes, the trajectory of my life changed and I found a place out of the flow that I really liked. It was more than a refuge or a sanctuary, it was just as interesting as I could’ve imagined. I’ve said it here a lot, but I had no idea how cloistered it was, and I’ve used the Rip Van Winkle analogy to the point of monotony. Today, I worked in the clinic where I volunteer – a plenty busy day. But it’s always the same. When I work as a psychiatrist/doctor, I don’t get into the tangles I can get into thinking about the things I write about.

I just looked over the comments, and I appreciate the input. I wasn’t kidding that I need to put the blog in the background and learn some new stuff for a big project. But I think I also need to think some about what that comment space is about. I haven’t really done that. I enjoy reading what people have to say, and there are lots of times when what I write about has been shaped by what I read there, but most of my energy goes into the content and topics I’ve followed.

The Internet is something new. I am a not-so-closet nerd and was on the Internet World Wide Web right after Al Gore Tim Berners-Lee invented it. I built an early site, The Way of Javascript, that was a tutorial that taught the first language that took the technology beyond just documents with links as it might be done by a Zen Master. Grand fun. And that was only 20 years ago. But the on-line interpersonal world hasn’t been a part of my life with its Avatars, Archetypes, infinite recesses, and the not so Zen Ways of Social Media. So I think I’ll just let that space and its vicissitudes simmer for a bit while I do this other thing, and see what bubbles up. If I’m to provide such a space, I guess it’s my responsibility to know what it’s for…

    Steve Lucas
    November 7, 2014 | 9:49 PM

    There is clarity in work. A task must be accomplished, we use our knowledge and experience to accomplish that task, and at the end, there is satisfaction with a job well done.

    The issue becomes how we characterize that task and the value we, or society, place on that task. Society often tries to take the task that we perform and turn it into profit for a small group, while we may look at it as only work.

    Nature abhors a vacuum so a comment section becomes a forum for many people with many different psychological goals. Anonymity creates a whole host of social issues. Buried traits come to the fore and we find assertiveness in people who other wise would be very social.

    Computers have created changes in our social structure. Any person with a computer can drag out an argument with an endless string of references all in an attempt to wear down the other person and declare victory when they leave the field in disgust.

    The clergy openly talk of the feminization of church. No longer run by the male businessmen of the 50’s or 60’s there is now endless discussion of every idea and never a decision.

    Then there is the work. People hurt and need assistance. There is a stack of numbers that needs to be analyzed. Then there is the blog with that great opportunity for comments and the equally great opportunity for abuse.

    Work is simple, direct, clear cut, with instant measurements. The rest of life is complicated.

    Steve Lucas

    November 7, 2014 | 11:27 PM

    I don’t visit much, so I had to back up and read the comment-storm after the fact. Sorry it happened here, but as several folks noted it’s nearly inevitable in an unmoderated discussion online.

    Tim Berners-Lee didn’t invent the Internet. The Internet has been around since before 1976 when I first logged on. Many years of text-based cultural history preceded TBL’s introduction of the World Wide Web (i.e., websites). I bring this up not only to out-nerd Mickey and to show I’m pretty old, but also to make the point that the dynamics of online discussion have been studied for several decades now. Scholarly works have applied Wilfred Bion’s “basic assumption groups” (described in a recent post) to online groups. Tech evolves, but there’s nothing new in human nature.

    It’s good to take a critical look at online commentary. What is its purpose in this particular venue, and what are the trade-offs? My own view, which is worth just about what you’re paying for it, is that talk becomes too cheap, i.e., disrespected, when there is no moderation.

    Best of luck with the new project.

    November 8, 2014 | 4:17 AM

    Dr. Reidbord, normally, I agree with you about forums needing to be moderated. But as a person with sleep apnea, I have learned more from visiting cpaptalk.com, an unmoderated forum than I have from any of the sleep doctors I have seen. My experience is quite common by the way.

    Yes, there are threads that get out of control every now and then and some of us will wonder why the heck we visit this site:) But then we remember what we have learned and realize the benefits greatly outweigh the negatives. And things always settle down until the next controversy:)

    James O'Brien, M.D.
    November 8, 2014 | 1:33 PM

    Every counterestablishment movement will eventually attract sociopaths and crackpots. There are no exceptions to this rule through history. This was true with the sixties counterculture and more recently the Occupy movement. It was even true of the American revolutionaries (Whiskey Rebellion). One should never assume the enemy of one’s enemy is necessarily one’s ally. That person may become the lightning rod that discredits the entire movement.

    November 8, 2014 | 4:57 PM

    I worked on Darpanet in 78′-80′. Didn’t get a computer and internet access until 1998.

    BTW, Al Gore never said he “invented the internet”. That was one of many lies the press told about him. He authored the legislation that made it happen.

    November 8, 2014 | 5:40 PM

    Thanks for your essays, Dr. Reidbord, I was also on the WELL, a little later. It was as you say. On the WELL, the meta was the message — over decades, the participants exhaustively observed, cataloged, and analyzed online behavior constantly. They tried it every which way; moderation won out.

    There is also a fairly extensive literature about identity, the construction of personas on the Web, and “authenticity.” (cf “On the Internet, nobody knows you’re a dog” http://en.wikipedia.org/wiki/On_the_Internet,_nobody_knows_you%27re_a_dog)

    As we have seen here, where a doctor gratuitously attacked a doctor, lack of anonymity alone does not limit inappropriate online behavior.

    Among professionals, one would think that self-interest — the construction of a flattering online persona — would lead to self-moderation. (In a support group, self-interest might well compensate for lack of moderation, as individuals are dependent on the goodwill of the group for support and information.)

    Online, there are usually many more readers than there are commenters. Reputations are made or lost among this vast invisible audience, too. (Mickey might know what his traffic is.)

    (New Yorker cartoon http://www.condenaststore.com/-sp/The-research-shows-that-rats-who-comment-on-line-are-dumber-than-rats-who-New-Yorker-Cartoon-Prints_i8772816_.htm One white-coated researcher to another: “”The research shows that rats who comment on-line are dumber than rats who don’t.”)

    In addition, a prospective employer, customer, or patient with decent Googling skills could find those intemperate posts revealing the unflattering side of a commenter’s personality: pettiness, arrogance, meanness, boorishness, assumption of privilege, prejudice, infantile acting-out, fuzzy thinking, etc. and draw conclusions with repercussions in the real world.

    And, if you fantasize you’ll have a biographer some day — well, everything on the Web lives forever.

    So, if you wish to argue for the right, because of your university degrees, to abuse fellow commenters or dispense tough love, there are many more judges watching you than the moderator, and intemperate words can follow you for a long, long time.

    James O'Brien, M.D.
    November 9, 2014 | 2:24 AM

    I strongly support the suggestions of the last post. I encourage all readers to fully vet the posters including the aliases through Google and especially YouTube searches.

    Bernard Carroll
    November 9, 2014 | 6:17 AM

    Indeed, there are revealing and unflattering things easily found out there about some aliased commenters. When they escalate to a state of intense affect and anger as we have seen here their words do come back to haunt them. Others have called them out for such behavior on other weblogs.

    November 9, 2014 | 12:29 PM

    If you’re talking about me, please look at my comment on Duncan Double’s blog http://criticalpsychiatry.blogspot.com/2013/01/the-challenge-of-reducing-and-stopping.html?showComment=1359479588150#c3639299063748847817

    Agatha, I would be happy to close my forum tomorrow if people could find the help they need from doctors.

    There are many forums like mine, providing peer support for tapering. They exist because of the vacuum of expertise in medicine.

    Every single person who shows up on my forum and the others would rather get their tapering advice from a doctor. I’d prefer this, too….

    This has been my position for years. There is a vacuum of knowledge, I urge doctors, particularly psychiatrists, to acquire the knowledge so they can better treat patients (and, incidentally, enhance the reputation of the specialty).

    Further, I say in http://criticalpsychiatry.blogspot.com/2013/01/the-challenge-of-reducing-and-stopping.html?showComment=1359510054308#c2505739627795651031

    I want to thank Dr. Double for considering my arguments, and for agreeing to be listed as a doctor knowledgeable about tapering for people in the UK who wish to go off psychiatric drugs.


    My great heresy seems to be that I say, repeatedly, that lack of a particular expertise, which would be easy to acquire, among psychiatrists is readily apparent to patients. It’s not theoretical, it’s not trivial, it can’t be waved away — it puts millions of people at risk. Psychiatrists should learn it.

    (See someone posting as James OBrien on the quality of clinical psychiatry here http://real-psychiatry.blogspot.com/2014/02/an-obvious-response-to-psychiatry-gone.html?showComment=1392049794333#c5042882895289544230_)

    My general position on drugs is the same as Terence Young’s, which is the basis of Canada’s Vanessa’s Law http://1boringoldman.com/index.php/2014/10/25/vanessas-law/#comment-260271

    I heartily recommend you all viewing my lone YouTube video — I’ll make it easy, it’s at http://youtu.be/x6vx8Eapo_4a vicious screed against cold-turkey off psychiatric drugs.

    November 9, 2014 | 12:52 PM

    In case you’re referring to me (so much for “anonymity”), please view my comment at http://criticalpsychiatry.blogspot.com/2013/01/the-challenge-of-reducing-and-stopping.html

    ….I would be happy to close my forum tomorrow if people could find the help they need from doctors.

    There are many forums like mine, providing peer support for tapering. They exist because of the vacuum of expertise in medicine.

    Every single person who shows up on my forum and the others would rather get their tapering advice from a doctor. I’d prefer this, too….

    Followed by
    I want to thank Dr. Double for considering my arguments, and for agreeing to be listed as a doctor knowledgeable about tapering for people in the UK who wish to go off psychiatric drugs.


    My heresy is that I say, repeatedly, that the lack of knowledge in a specific area by psychiatrists is apparent to patients and reflects badly on the profession. Lack of knowledge about adverse effects, particularly withdrawal syndrome, is not theoretic, it is not trivial, and it cannot be waved away. Millions of people are at risk; patients are being injured daily.

    (Here’s someone posting as James OBrien on the general quality of clinical psychiatry http://real-psychiatry.blogspot.com/2014/02/an-obvious-response-to-psychiatry-gone.html?showComment=1392049794333#c5042882895289544230)

    My position on drugs in general is the same as Terence Young’s, the basis for Canada’s Vanessa’s Law http://1boringoldman.com/index.php/2014/10/25/vanessas-law/#comment-260271

    I urge everyone to view my lone YouTube video — I’ll make it easy, it’s at http://youtu.be/x6vx8Eapo_4a vicious screed against cold-turkey off psychiatric drugs.

    James O'Brien, M.D.
    November 9, 2014 | 2:35 PM
    Steve Lucas
    November 9, 2014 | 2:54 PM

    What is hateful to you, do not do to your neighbor. This is the whole Torah; all the rest is commentary. Go and learn it. – Hillel, Talmud, Shabbath 31a

    November 9, 2014 | 3:05 PM

    Sorry for the repeated posts. That was an InterWebs glitch.

    Are we in the scapegoating phase now?

    November 9, 2014 | 5:53 PM

    Altostrata has already won this battle so it would be best to move on.

    Altostrata, as much as I have appreciated what you do in your real life, it often does not show in your behavior here. I am neither a mental health patient or a professional, but rather someone looking into this situation.

    What I see when your debates turn into arguments with vitriol is someone who is either unable to lose an argument or wants to lash out or both.

    You frequently ask me to see how bad physician behavior is, and then I’ve watched for going on two years how you’ve practiced the very same behaviors.

    Should I expect more from physicians? Yes. But, in the strange logic that is in my head, I actually expect more from you because presumably you know better since you’re the one calling it out.

    And, now you’ve gone and played the “I’m only trying to do good” and “I’m a victim” cards. You never need to do that to win an argument, although they do always bring a win every time they are played. I thought you’d be above that, but this is war after all.

    Yet, I’m not sure how doing good negates your own behavior? I assume the doctors here have also done good or are trying to. And, where were you when others here have been piled on? Did you not care because they weren’t on your side of the “battle”.

    Even as I write this I know that you will not have a clue what I am talking about, and I feel for you that you can’t or won’t.

    November 9, 2014 | 5:56 PM

    As a nurse who has been helping people withdraw from psych drugs for the past 4 years, I strongly recommend Traditional Chinese Medicine- acupuncture and Chinese herbs. I have found no meaningful assistance from the lot of psychiatrists I know from 20 years as a child/adolescent psych nurse. Most of the MDs who prescribe these drugs start out *clueless* regarding their actual effects. The MDs I know have less than meaningful rapport with their patients and worry over things like: can I bill for this? and, what is the liability factor?

    I work with a very good Chinese Medicine practitioner, who initially sought me out (I am also her patient) to assist her with language and cultural obstacles she was encountering with patients who were asking for her help with psych drug withdrawal. I also have certification in Cranio-Sacral therapy and am a Reiki master. I have incorporated several alternative/complimentary practices into my own wellness routine that I share w/ clients. Correcting patterns of disharmony and addressing the neuro-muscular deficits that result from long term use of psych drugs (NIA, Qi-gong) is the gold standard in my practice/experience in this *new specialty*.

    In my mind, it is impossible to reconcile the breach of science, morals ethics, committed by psychiatrists–It amazes me that the AMA does not simply remove psychiatry from its list of medical specialties–

    Sure, let psychiatrists practice *something*– but it should be what people want and need–meaning no more *treatment by force* and by no means should any psychiatrists EVER have prescribing privs– or a license to diagnose ANYTHING. Let them hang out a shingle– and compete for the opportunity to assist people seeking help.

    Though you have been pleading for licensed medical doctors to help you assist people to safely withdraw from psych drugs– for what I respect as your sincere belief that having an MD supervise the tapering is the safest way. My 40 years nursing experience leads me to believe that doctors are not going to police their ranks, atone for their mistakes, much less apply themselves to study and develop a means for repairing the damage they have done. Why? Because first they have to admit to wrong doing– and that is very unlikely–

    No worries, though– just one more reason to realize how little we need them 🙂

    November 9, 2014 | 5:57 PM

    Sorry, I am biting, per Altostrata’s first comment at the thread:

    “There is a vacuum of knowledge, I urge doctors, particularly psychiatrists, to acquire the knowledge so they can better treat patients (and, incidentally, enhance the reputation of the specialty).”

    Please define what a “Vacuum of knowledge” means to you. Because if you infer we don’t know almost everything, well, that is humanity, and not just unique to psychiatry.

    Oh, by the way, I am really tired of this “psychiatry could do better” crap that is regurgitated daily at sites like this by the usual people. Yeah, we could, if you would turn your wrath and indignation onto both insurers and politicians that profoundly restrict what we can offer as well trained providers. It ain’t just about writing for certain prescriptions that is the problem for mental health care.

    The irony is, the abolitionists so want psychiatry minimized and restrained, you now have the consequences: PCPs writing most of psychotropics without much of a clue, insurers telling everyone what meds and other mental health services are “authorized”, and politicians shutting down inpatient units and then criminalizing fairly much everything that people who are marginalized to the streets are trying to do to survive;

    Case in point to the last example:

    Arresting and fining people for feeding the homeless, just priceless. And I will bet that the politician(s) behind this are most likely long standing incumbents.

    yeah, we are in the scapegoating phase, for most railing away about psychiatry, wouldn’t we say the abolitionists have been doing it for what, more than 10 years now?!

    Remember, those who scapegoat are never satisfied until, as Darth Sidious said in “The Phantom Menace” near the end, “wipe them out, all of them.”

    It certainly is a narrative throughout the MIA site, read for yourselves…

    berit bryn jensen
    November 9, 2014 | 6:26 PM


    Seikkula et al, tolerating uncertainty, polyphony, listening to those in need of help, and those willing and able to help… no semented expert position, dialogue, life, learning, flexibility, movement, human growth, change possible with no drugs or minimal use.

    November 9, 2014 | 7:11 PM

    Arby, thank you for your comments. I will moderate my overzealousness in the future.

    Sinead, I agree with many of your points. I guess I maintain some illusions about doctors. But there’s a terrible shortage of people like you and knowledgeable alternative practitioners in this area, too. (Please contact me.)

    Joel, the answer to your question is contained in my post(s): Lack of knowledge about adverse effects. BTW, I thought you were unfairly harried on MIA, but it’s a snarky culture there.

    berit bryn jensen
    November 9, 2014 | 7:27 PM


    The psychiatric profession is in for ever more competition from people with lived experience harnessing their own creativity together with artists and a broad variety of thinkers, professionals and amateurs exploring better ways to growth and healing than the cul de sac of toxic drugs.

    November 9, 2014 | 7:50 PM

    Start with the good first in reply to AltoS’s last comment: thanks for noting the demeanor of MIA, or rather just mean there.

    Now, for the not so good…

    Yeah, there are providers who have a “lack of knowledge” of adverse effects”, even lack of applicability with a vague or wrong diagnosis, BUT, you extrapolate that to fairly much ALL of us. Time for that loud and obnoxious “Eeehhhhh” noise in game shows when wrong answer is given.

    It is a multifactorial process to illness, and to treatment, I know that, and when the interventions apply that paradigm, patients seem to get better.

    Hopefully excludes me from the riff raff you might actually be able to complain about, but, hey, I do the best I can with what little I am offered these days…

    James O'Brien, M.D.
    November 9, 2014 | 9:02 PM

    Is Eastern medicine effective against projection, denial and splitting?

    I don’t know if we are in the scapegoating phase, but we are in the res ipsa loquitir phase. Some of these aliases have truly revealed themselves but for their name.

    November 9, 2014 | 10:05 PM

    When I compare the knowledge base of psychiatry to the knowledge base in the areas of general medicine I worked in for 15 years, I have no explanation for how psychiatry ever became a specialty in the science, empirical –
    evidence based practice of medicine.

    Since 1988, when I first entered a psychiatric setting as a nurse,I have witnessed the creation of Bipolar disorder, and the creation of the pediatric market for psych drugs. I’m just a nurse, but from where I sit these *crimes* against vulnerable people cannot be reconciled in terms of the “biomedical model” of psychiatry. I witnessed absolutely no respect paid to the patient’s subjective experience, and no evidence of conscience for the suffering of the victims– . Two key elements for the problem oriented approach to medical treatment : the patient’s own words and their response to interventions- obliterated entirely on an inpatient psych ward.

    The development of my practice as a nurse and advocate is centered entirely on models of care that recognize and honor the dignity of the lives of the patients that have been labeled, marginalized, drugged and written off by psychiatry. The success I have witnessed in my practice is amplified in recovery, peer run communities , where the efficacy of human responses to human suffering– is a sight to behold!

    IF there really are psychiatrists who aspire to alleviate the suffering of vulnerable people , one would expect them to be flocking to these recovery communities to learn how to support people thru crisis to recovery. Sandra Steingard is the only psychiatrist I know of who has begun to seek out knowledge and experience in these humanistic places.

    I chose nursing in the early 70’s, when it was fairly common to view nursing as a modest, but respectable profession undertaken by people who wanted to care for the sick and disabled– I had no direct involvement in the evolution of health care as big business– and I have no intention of making excuses for not continuing to make the care and well being of patients my priority–.

    I might make some effort to sympathize with the psychiatrists who feel unjustly penalized, vilified or oppressed due to political and corporate transgressions– IF I did not know from up close personal experience that the patients, the people, and most of , the children who continue to be harmed by this *crazy cult* called, psychiatry, are the priority.

    I am just a nurse– forgive me for placing the patient’s well being above the ego of the doctor– it’s a habit I just cannot break.

    November 10, 2014 | 12:21 AM

    Dr. O’Brien,

    I am not sure if you meant me in your latest comment but in looking back I can see where I could be misinterpreted.

    If that is the case, and if Dr. Nardo is willing, you can get my email from him and we can discuss.

    You needn’t use your actual email. You can make up some random gmail account and email me using that.


    November 10, 2014 | 12:23 AM

    I would like to address your question:

    “Is Eastern medicine effective against projection, denial and splitting?”

    I would have to say, yes, it is effective in all ways that promote an individual’s experience of wholeness –, which does directly strengthen the ego, and would thereby decrease the need for defense mechanisms to be deployed.

    It would be a great advancement for the mental, physical and spiritual health of our society, imo, IF there were a strong movement toward integrating Western biomedicine with Eastern Medicine. The barrier to progress seems to be a rigidly held bias toward one way of viewing the human being, which discounts the interconnectedness of mind and body.

    There are actually many ways to effect positive changes in mental states and moods via *body work* and sensory/motor stimulation, that also improve one’s state of physical health.

    Traditional Chinese Medicine did not develop from dissection of human corpses, and pretty much assigns the brain a low priority , as it is not a focus for treatment. However, in all vital ways that our brains serve to make us human and capable of achieving happiness, Chinese Medicine promotes brain health.

    The Chinese are leading the way toward fully integrating Eastern and Western medicine–. A study of the philosophy that created the cultural climate for this, shows that the primary concern is first and foremost, “What works?”– which definitely led to a more inclusive attitude toward foreign medical treatments.

    Can we become truly open minded??

    Hope so–


    James O'Brien, M.D.
    November 10, 2014 | 12:45 AM

    I certainly think that the man sitting under the Banyan tree had some good ideas about the antidote to narcissism. Many Westerners need to focus more on truth than feelings. I’m down with the philosophy, however as far as the medicine, I’d like to much of it put under the same standards we hold pharma to. I hope you’re right, but it needs to be tested. In which case it will become part of Western medicine.

    I’m also noticing my sunlight theory and philosophy is being vindicated…

    As Dr. Carroll says, it’s not about us and our feelings.

Sorry, the comment form is closed at this time.