Tilling the Institutional Soil in Kraeplin’s Kingdom:

As many know, Emile Kraeplin (pronounced crap-land) formed the magical thoughts that are the basis of mainstream DSM propaganda that forms the businesses and billing systems that occupy the nation’s mental health. Though the idea that an observable behavior is the result of a specific brain dysfunction is more magical than proven, many feel it is best to uphold it to maintain social order. This will save jobs and maintain the power of political action committees that advocate for them, like the AMA the APA, and the big pharm PAC (pharmaceutical industry.) Still if people can grow anyway managing the manure in the pastures in effective manners if they learn to work together.

With a dominant discourse that assumes pathology, and exacerbates stigma myths that I have seen Patrick Corrigan define in lectures as: 1) danger; 2) developmental regression, and 3) loveable buffoonery; a sense of community can remain behind barb-wire confines of old institutional white walls, leaking urinals, in unheated or drug infested homes, sometimes tended with authoritarianism midst cigarette smoke, throughout days without a sense of meaning and purpose or inclusion in the monetary system.

Well-intended peoples who take home the money society prescribes for these hacienda communities may run patrol making assessments about what is real without an understanding of what the message experience is like.  Such workers eyes may operate with a subsequent skewed sense of their own power and health and without being encouraged to study or understand the process of the culture they work with. As a result well-intended people may not always hold high regard for the likeliness of competence and recovery that exists therein.

The purpose of this work is not to set off a bomb in such communities.  People trying to help may have had no training courses about what “psychosis” is and don’t realize that they may operate in manners that may exacerbate the condition.  If they have had the experience of an abnormal psychology course like the one I took, the understanding of psychosis may be full of fact distorting twin studies and brain scans; and magical, eugenic, disease-oriented thinking.

Many helpers don’t seem to consider the idea that people do live meaningfully with the experiences. All must adhere to, and some internalize, mainstream magical thinking. There is the differential labeling system of oppression divides individuals into labels and may not encourage them to systematically look for the similarities they have with each other. In essence there is an unintended mentality of divide-and-conquer that starts with the language of labels as if the Mad were to look to each other for an explanation of what is happening to them, that their loved ones would never get them back.

This work asks participants to consider the traumatic effects of being harshly judged on the basis of a desperate behavior; then treated in potentially inhumane manners.  This work envisions a system that is not hell bent on dominating and bullying these behaviors into change via punishment.  It looks at the manner in which the current social system oppresses and marginalizes.  Mainstream supporters, often impassioned toward bullying because they are fearful that if they don’t, they may cause irrevocable brain damage; social loss; or lead to permanent incarceration; or homelessness. Many such helpers may later look at the effects of their best intentions and declare: incurable disease proven.

While the experience of psychosis is involuntary, hospitalization, forced medication, seclusion and restraint so often result in a sense of feeling punished.  Too often the observable benefits of medication, which I do not argue need to be entirely disposed of, are heralded as the only hope for improvement, and treatment ends up being forceful in ways that can exacerbate trauma.

For some forced and in a state of emergency, clinical culture that records notes to justify payment may seems to resemble a U.S. prison with a diminished sense of justice and no sense of the potential for recovery.  One of the reasons for the oppressive culture that develops is an odd sense that acknowledgement or inquiry about the world that exits in the rabbit hole will make community members worse.  Thus, if one of those individuals receiving Special Messages starts to express themselves in ways others may not understand, they get halted.  It might bring up trauma that these people cannot handle.  Notes get written about that person’s ineffectual manner.  They get repeatedly told about how to behave as though their true experiences have not valid meaning.  They may be directed to focus on little kid things like hygiene in ways they stop listening to.  Oddly, hygiene may get worse in rebellion.

I recall early in my career a woman staying at a crisis house I worked in saying, “Okay, it’s time to clean the cans!” Throughout the day she had made reference to cleaning the cans and I had no idea what she meant. And, then, as she dunked the brush into the commode she exclaimed in the most oppressed of manners, “when they tell you to clean the can, you clean them . . . clean the cans, clean the cans, clean the cans.” While at the time I think I managed to handle this in a way so that we both had a laugh, her point reverberates in my mind: why listen when your sense of rights and ownership in the poverty of your board and care home or single room occupancy hotel remains. Why do what you’re told, when you don’t get anything for it, not even a safe place to live with some young kid telling you what to do.

“Don’t go down their rabbit-hole,” is the best advice of the well-intentioned, best educated of our clinical experts.

“Establish a relationship by separating your understanding of reality from theirs,” is the pervading mentality by CBT for “psychosis” experts.

While this wisdom may be the best psychiatric folks can do because they don’t understand processes of “psychosis.”  This work seeks to change this.

Excerpted and revised

Author: Tim Dreby

I am an award-winning author and practicing psychotherapist

3 thoughts on “Tilling the Institutional Soil in Kraeplin’s Kingdom:”

  1. I really appreciate this post – it matches many of my thoughts on diagnosis, the disease model of mental health, and the treatments usually provided.

    While there are undoubtedly people who benefit financially from our current system of diagnosis and medication (ranging from pharmaceutical companies to insurance companies to individual mental health providers), I believe the vast majority of these people are well-intended and not malicious. But, as you pointed out, being well-intended doesn’t mean what is offered is inherently helpful.

    I agree with your observations about the magical thinking engaged in by clinicians in diagnosis and treatment (I’ve found myself falling into that way of thinking at times!). This confirmation bias in mental health treatment is unscientific at best and self-fulfilling (in a potentially harmful way) at worst. If clinicians start with unproven assumptions (e.g. diagnoses are caused by underlying brain/biological dysfunction) and look for evidence/examples that confirm this assumption while explaining away evidence/examples that aren’t consistent with the assumption, then this skews perception of reality.

    More importantly, if patients are told repeatedly that they are broken (different terms are usually used like ‘chronic illness’ and ‘underlying brain disorder’ but when combined with telling them there’s no cure and it’s often lifelong, that message gets across) and treated like they are broken, they are more likely to believe they are broken and to act/think in ways that reinforce the idea that they are broken.

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  2. Thank you Stacy. What you say is so true. The fact that the whole system is built around this invalidating and erroneous logic gives it so much power. It shows the power of language. In future posts I will argue that we need to establish our own language. I dabble with calling it gooney-goo-goo jargon. That power! Gooney-goo-gooism. Stay tuned and thank you so much for your ongoing supportive comments. They mean a lot to me.

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    1. You’re welcome — keep the posts coming!

      I’ve been pondering the idea of language and power since I read your reply a couple days ago. My first thought was that the power in oppressive/stigmatizing language comes from the authority figures (and surrounding system) that have created it and perpetuate it. (i.e. medical doctors and counselors define mental health vs mental illness, diagnoses, and treatment and their assumed expertise gives all these definitions their power.)

      Which made me wonder if creating a new language/jargon would only be powerful if the group creating it was already assumed to have authority. I’ve seen examples of groups of people taking the destructive power out of language, usually taking words intended to be insults and owning them with pride (the best example I can think of at the moment is ‘queer’ being adopted with pride in the LGBT community which took the ‘sting’ away from it being used to insult/berate people).

      So now I’m intrigued by the idea of adopting new language/jargon. My guess would be that fueling the movement with pride and a sense of community/belonging would be the most effective. But I’m curious to see what you had in mind!

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