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Voices and Visions from Outside Mental Health
Updated: 43 min 39 sec ago

Cannabis for Treating Psychiatric Problems? A Clear Yes, Maybe.

Sat, 08/29/2015 - 17:42

Marijuana is now legal in two states, and legal for medical use in 23 states and the District of Columbia. Polls show the majority of Americans support cannabis legalization, and more and more of the country is joining the legalization trend. As a counselor working with people diagnosed with psychosis and mental illness I am often asked about my opinion and clinical experience — as well as my personal experience — with medical cannabis.

The issue is not clear-cut either way, but I think it is time for everyone, especially if you are concerned with the risks of pharmaceutical drugs, to set aside what we think we may know and take a serious look at cannabis as an option for people with serious mental health challenges. Medical use of marijuana has clear potential for reducing psychiatric drug use, drugs that are notorious for their devastating adverse effects. The decision to use cannabis is not simple, and along with the War on Drugs anti-pot propaganda there is also a lot of pro-marijuana fanaticism to wade through, but this is the reality: many people can forgo pharmaceutical drugs and use cannabis instead.

I don’t need to reiterate the extensive research on medical use of cannabis available on the internet, and I have already written about cannabis and substance use in counseling practice in a previous post on Mad In America (‘The Substance of Substance Use”). But here are some more thoughts about cannabis specifically.

There is now widespread evidence people are already successfully using cannabis to treat psychiatric conditions. Cannabis has long been used as medicine and spiritual tool throughout human history, for for far longer than the brief period of prohibition when it’s been criminalized. Criminalization didn’t come from medical assessment of cannabis’ usefulness, but was instead a political decision motivated by racism and suppression of the insurgent youth culture. Extensive studies showing medical benefits — for cancer, Alzheimers, multiple sclerosis, hepatitis C, irritable bowel, Parkinsons, pain management, and other conditions — have driven ballot initiative success around the country. This has begun to convince even longtime opponents, with US President Obama formally acknowledging cannabis as no more dangerous than alcohol, and CNN’s chief medical correspondent Dr. Sanjay Gupta, one of the world’s most influential opinion leaders on medicine, recently reversing his opposition to medical marijuana. Dr. Gupta even apologized for his previous anti-legalization stance and “not looking hard enough” at the issue.

But what about mental health conditions?

Around the country, medical marijuana cards are routinely given to people suffering anxiety, depression, insomnia, ADHD, trauma, and mental health issues. The internet is replete with a growing number of testimonies of successful symptom alleviation through cannabis, including people diagnosed with psychotic disorders such as bipolar and schizophrenia, These are not just a few anecdotes, these are thousands of people giving firsthand accounts of benefitting from cannabis for mental health conditions. And with the growing number of dispensaries, review websites, and legal cannabis consumers, these testimonies are growing in number.

And at the same time, it is not uncommon for me to receive emails like this:

“Our son was doing so well in school, and then he started smoking marijuana and went psychotic and went into the hospital, where he was diagnosed with schizophrenia.”

“Before her delusions began I learned she was experimenting with marijuana…”

So what is going on?

Our culture has been saturated for years with a simplistic prohibition mentality around marijuana. Media reports demonize cannabis, with many scientific studies were twisted and manipulated to support a political agenda. Just one notorious example was the Heath/Tulane study in 1974. which claimed to show marijuana “kills brain cells.” These findings, reported by a mainstream research institution with impeccable scientific credentials, were considered gold standard evidence and quickly became part of the mainstream attitudes. “Marijuana kills brain cells” was paraded by President Reagan in his anti-drug propaganda and brought out by frightened parents everywhere when they discovered a joint in their teenager’s bedroom. The study even supported extremist media campaigns like the “This is your brain on drugs” television commercial, where a broken egg on a hot griddle became the last word on marijuana dangers.

The Heath/Tulane study was later exposed as pure scientific fraud: researchers were able to show brain cell death only by pumping so much marijuana smoke into the laboratory animals that the animals couldn’t breathe. It was asphyxiation from lack of oxygen, not ingesting marijuana, that caused the brain damage. The poltiicization of science continues, and Dr. Gupta writes that of current US marijuana studies, 94% are designed to investigate harm, not potential benefits.  Despite countless other studies showing marijuana’s benefits and extremely low risk profile compared to either tobacco or alcohol – two very legal and very deadly drugs — we have let prohibition politics, not solid science, shape and continue to determine US drug policy and leadership worldwide.

This corruption is even more true in mental health, where substance use has become synonymous with substance abuse, and the mental health system oversees abstinence-based treatments that are often the criminal punishment for users arrested for possession alone. No leading mental health organization has publicly expressed opposition to the War on Drugs or presented an honest discussion of the potential value of legalization. Mainstream mental health websites such as National Alliance for the Mentally Ill and the Schizophrenia Society of Canada continue to echo this demonization. Any potentially valuable caution about the role of cannabis use in psychosis – of which I will discuss more in a moment – gets lost and discredited in the general “just say no” message. There is no balanced discussion, not of how cannabis might help some people forgo the risks of psychiatric drugs relative to the possible risks to adolescent brain development. Mainstream opinion makers, driven in part by pharmaceutical and American Medical Association opposition to legalization, have instead elected to emphasize the psychosis-marijuana link research and ignore everything else.

NAMI medical director Dr. Ken Duckworth sums it up on the NAMI website “The overwhelming consensus from mental health professionals is that marijuana is not helpful—and potentially dangerous—for people with mental illness.” He doesn’t point out that this consensus is a result of politics, not medical science. The rest of the policy document has War on Drugs propaganda on full display. Dr. Duckworth writes, “Approximately one-third of people in America with schizophrenia regularly abuse marijuana.” Really? Can we see a study citation for that statement? The answer is no, there is no citation because NAMI made this claim up, there is no research behind it.

Dr. Duckworth also rings the alarm bell of addiction, counting the mental health industry’s conflation of use and abuse. He states that “a significant percentage of individuals who use marijuana will become physically dependent on the drug. This means that stopping their marijuana abuse will cause these people to experience a withdrawal syndrome.” Dr. Gupta, however, disagrees. Dr. Gupta writes on CNN that “In 1944, New York Mayor Fiorello LaGuardia commissioned research to be performed by the New York Academy of Science. Among their conclusions: they found marijuana did not lead to significant addiction in the medical sense of the word…” He adds, “The physical symptoms of marijuana addiction are nothing like those of the other drugs I’ve mentioned.”

My bet is with Dr. Gupta on this one. As Dr. Gupta’s reversal indicates, there is a clear case for legalization of cannabis because there is an undeniable scientific research base — and common sense base – for cannabis’ benefits relative to its risks. As a recreational drug there is just no comparing cannabis risks to other drugs such as alcohol and tobacco. But in the context of the War on Drugs’ demonization, proponents of marijuana have reacted with a defensive romanticization, adding to the confusion. Left in a vacuum by mental health and medical organizations that should have been providing sound and honest discussion on the issue, the many mainstream research studies on medical benefits of cannabis are often touted and available on aggressively pro-marijuana sites. You feel that you are pulled to one side of the other in this political – and economic – tug of war. (The pro-marijuana sites are after all, now burgeoning with advertising revenue from the surfacing marijuana industry. The message today is “cannabis is good for you,” and of course the next message will be “buy some today” and then “from us.”)

As a society we are thankfully stepping away from both demonization and romanticization. And this means looking at two important facts about cannabis: dosage and strain. 

The cannabis of today isn’t the cannabis of yesterday. But the commonplace claim that “marijuana today is stronger than it was in the past” is far from the whole picture. Yes there is a lot more strong marijuana out there, but that also has positive implications for medical use. There is a an increased complexity and sophistication of how cannabis is being used, in many different ways by many different people, that has to be understood.

As far as dosage goes, the importance of understanding this complexity is well illustrated by the experience of New York Times Pulitzer Prize winning columnist Maureen Dowd. In a high-visibility, and influential, act that formed part of Times reporting on growing legalization efforts in Colorado and elsewhere, Dowd got high on pot in Denver. And promptly had a psychotic episode. She presumably didn’t go on to be diagnosed bipolar, and did not need to be hospitalized, but her bad trip, replete with delusions of being dead and paranoid fears of the police, for some might be considered proof positive that cannabis is a bad idea for anyone “at risk for psychosis.”

Dowd, however, was in effect writing a denunciation of wine by binge drinking on tequila. “Alcohol makes you sick and pass out” says more about how, how much, and what we drink, than it does that we drink alcohol. Simple enough common sense, but that is exactly what has been lost with prohibition propaganda. Without adequate understanding, Dowd apparently downed an entire cannabis infused edible candy. Edibles are notorious for their potency. Then she did what anyone following sensible marijuana use knows not to do – she gobbled up even more of the edible when she didn’t feel any effects after a few minutes. She doubled the eventual impact of the drug, and delivered a massive dose to her marijuana-naive self after the slow-onset that is standard for eating marijuana (smoking effects are much faster; eating means the cannabis has to be digested before experiencing amplified effects.). It could be humorous – Dowd was lambasted in the internet for her irresponsibility – if it wasn’t so emblematic of the impact of prohibition. Rational discussion by a presumably thoughtful professional journalist turns into nonsense, fuel for more simplistic demonization.

Dosage, including the delivery method (and now there are tinctures, vaporizers and other methods beyond smoking or eating), is an important reality to cannabis consumption. If a drug leads to psychosis at a higher dose, but doesn’t at a lower dose, is the problem the drug or its use? If a drug at one dose is useful and at a higher dose is harmful, does that mean the drug is “useful” or “harmful?” So we begin to see one explanation for how a drug that many people find useful for psychosis can be the very drug that causes psychosis for many others. It becomes more understandable that my email inbox has emails from people blaming marijuana for mental illness alongside emails from people who’ve been helped.

Dowd also didn’t chose her strain with any care, and strains can make a huge difference in cannabis use. There are hundreds of strains of crossbred hybrid cannabis, with colorful names like Blue Dream, Girl Scout Cookies, AC/DC, and Lemon Alien Dawg. This diversity isn’t just fanciful or aesthetic: strains differ by aroma and flavor, Much more importantly, different strains have drastically different psychoactive effects. Alcohol intoxication might feel a bit different between beer, wine, and spirits, but not by much The different effects between different cannabis strains are like taking completely different substances.

There are 483 currently known compounds in marijuana, and at least 84 different psychoactive cannabinoids. THC is just one. This may explain why some people are using marijuana to alleviate psychosis while others find it makes psychosis worse. Medical marijuana users routinely share information about the qualities of different strains – some good for sleep, some for anxiety, some for depression, etc – to help each user find out what works for them. Of the many alkaloids, cannabidiol (CBD) is associated with tranquilizing response, while THC causes more mind-altering, and is potentially paranoia and anxiety inducing. Similarly, marijuana users have long known that the sativa varieties are different than the indica; sativa is associated with a more energetic high, prone to produce anxiety and paranoid in some people. while indica is more sedating. There is strong evidence that high CBD cannabis can alleviate psychosis for the simple reason that is is tranquilizing, in the same way that anti-psychotics are for many people helpful because they are tranquilizing. CBD, however, clearly lacks the devastating side effects of antipsychotic drugs.

(The cannabis industry is still only now emerging from the underground, and with lack of the regulation and quality control of other industries users still have to rely on trial and error. It’s not a guarantee that what the dispensary labeled as Blue Dream isn’t actually Kali Mist, or there isn’t sativa in that tincture marked indica. Medical users will be better served by legalization, which will allow greater testing and reliability of supply, as in the wine industry. The best role of regulation in the legalization process is fiercely debated by growers concerned about issues such as ecological sustainability, labor conditions, and the specter of Big Tobacco-style profiteering. In Sonoma County where I live, there is a huge marijuana industry and vast sums of money moving into the state in anticipation of California following the trend towards full legalization. The legal wine industry in the area is very shady, and has a deserved reputation for greedy disregard for the environmental and local community in its rapid expansion. That might be a cautionary tale: the gentle peace-ecology-love aura of marijuana may, some fear, quickly give way to the cutthroat realities of just another boom industry and agribusiness product.)

Word about CBD is getting out. Along with the emails from people tracing psychosis back to marijuana use, I now routinely encounter people in my work, lucky to be in a legal state or country or able to risk acquiring pot through the underground, who are using cannabis to help with distressing experiences associated with psychosis and mental illness diagnosis. Some have switched strains to high CBD and found different effects, some are using cannabis to help come off psych drugs, some are using cannabis instead of psych drugs, and some – very interestingly – have gotten benefits from cannabis and never gotten on psychiatric medications to begin with. Scientific studies on CBD support what I am seeing: a University of Cologne study from Germany, in a four week trial, found CBD as effective as an anti-psychotic in calming psychotic symptoms. A co-author of the study wrote “Not only was [CBD] as effective as standard antipsychotics, but it was also essentially free of the typical side effects seen with antipsychotic drugs.”

A glance through research results on CBD from studies around the world shows evidence to support what we know already: CBD marijuana can help mental health conditions. These users are often careful in dosage, some even using just a few drops or “homeopathic” doses to get the desired effects.

(Other research is also intriguing. Numerous studies show anxiety alleviation, and, consistent with studies on Alzheimers and Parkinsons, one University of Montreal study published in Psychiatry Research even showed cannabis users diagnosed with schizophrenia to have better memory and prefrontal lobe functioning than those not using cannabis. Could cannabis be not only a substitute for psychiatric medications, but a treatment for the harm they caused? And other studies that are more troubling, such as those showing memory impairment and youth development harm, are essential to come to terms with in any benefit/risk assessment, but what do dosage and strain have to do with the results these studies found?)

So the kind of cannabis used, as well as the dosage, may explain part of the puzzle of different reports around cannabis and psychosis. This is in addition to a general principle with all psychoactive substances, a principle that applies to cannabis as well:

Response to cannabis use is widely diverse and individual. The medical marijuana dispensary community is thoroughly familiar with the fact that as a “medicine” cannabis does not provide uniform “treatment.” Instead, just as each individual experiences “illness” differently, each individual has their own response, and what is right for one person might not be right for another – including the need to forgo cannabis altogether. Some people find the “high” contributes positively their medical condition and life circumstnaces, others seek out strains that have helpful effects without the high. Dispensary staff I’ve met are skilled at helping individuals navigate different strains and dosages for individual needs.

Substance abuse is a serious and devastating problem. Some people find that abstinence is the best strategy, such as following an AA 12 step program. Taking any drug – alcohol, tobacco, or cannabis — involves risks. Cannabis needs to be subjected to the same caution, but overall cannabis is undoubtedly much safer on the body than alcohol or tobacco (zero marijuana caused deaths compared to many millions of alcohol and tobacco deaths) and much safer than any psychiatric medication. The growing legalization and medicalization of cannabis will no doubt be used by some to rationalize their addiction or avoid facing the fact that the drug is not helping them – but this is true of any substance, including alcohol and psychiatric meds. Once we step outside the demonization/romanticization polarity of the War On Drugs mentality we can engage this complicated reality more clearly. Saying cannabis might be helpful for some people is not to deny it might make others worse.

What about me personally? I found years ago that marijuana only worsens my own anxiety and further disconnects me from reality. I was smoking around the time I was first hospitalized, and though I quit marijuana I still had another psychotic break many years later when I wasn’t using and hadn’t used marijuana for 8 years. I do believe that pot was a contributing – but in no way a causal – factor in my first crisis, however, and that smoking played a role in the several years onf decline that led to that crisis. But tellingly this was all wildly overstated by the hospital doctors who interviewed me. When I moved to Conard House, an outpatient facility in San Francisco, I was sent to a mandatory anti-drug meeting along with every marijuana user at the house, regardless of the frequency of use or whether or not it was abused or a problem. When I challenge the meeting leader by saying that marijuana was much safer than alcohol, I was kicked out of the program. (I was sent to a homeless shelter at 14th and Mission, right next to a thriving street crack market where I passed dealers every day on my way to and from my room. A good friend of mine from a previous program, who had been abstaining from cocaine for several years, was sent to the same shelter, I watched as he gradually lost control of his addiction with the temptation of those dealers; he left the shelter and I never heard from him again.)

I think that CBD strains are promising, and I personally would not hesitate to try a small dose of CBD marijuana in a time of emotional distress where I felt I had run out of other options. I would watch carefully my response, and proceed only if I felt confident I wasn’t going to get paraoind or become anxious. Friends, clients, and colleagues who use cannabis have educated me about its potential if I did ever find myself in need, and have introduced me to the California dispensary system. I’m grateful I live in a state where I can learn about these issues and can first try a CBD brownie (gluten free of course) instead of a dose of Seroquel if I ever get out of hand with sleep deprivation or go off the deep end in a psychosis. And when I’ve seen friends go down to the psychotic vortex and head for the hospital, I wish there was some CBD weed around to try first to help them break the crisis cycle, rather than relying on a psych med as a last resort.

With clients I work with I now feel it is unethical as a therapist to not include cannabis in the list of possible wellness tools for those in legal states. I am pro-choice regarding psych drugs, and if I acknowledge that anti-psychotics, even with the risks, might be a wise choice for some people, I would be completely, well, crazy not to acknowledge that cannabis might be a wise choice for some people as well. I’ve always welcomed herbal medicine and traditional chinese and other treatments into the range of possible wellness choices, because they have such a demonstrated history of helping so many people. Cannabis also has such a history, and I believe everyone working in the field as a therapist or psychiatrist needs to consider taking the same stance I have.

From a mental health advocacy standpoint, marijuana legalization also has many other implications that we as mental health professionals should look at. The AMA, APA, NAMI and other groups have failed to meet this issue responsibly. An American Journal of Public Health study by a team of economists, for example, examined states that had legalized marijuana for medical use. The study found there was a 10.8 percent reduction in the suicide rate of men in their 20s and a 9.4 percent reduction in men in their 30s. That is extraordinary – we know that psychiatric drug use can exacerbate suicidality (the drug warning is right there on the label), and alcohol of course can contribute to suicidality. It’s not clear exactly why greater availability of medical cannabis might lower suicide rates, but this is a very, very significant finding to study further for anyone who takes suicide prevention seriously. (I recently lost a dear friend to suicide, and I am convinced benzodiazepines and alcohol played a role in killing her. I wish her therapist and doctors had explored cannabis as an alternative – she needed any alternative – and her death is one of the things motivating me to write this blog post and “come out” with my clinical practice decisions around cannabis.)

Studies also show reduction in alcohol use results from legalization, which, again, has enormous implications. Alcohol is an extremely dangerous and socially destructive drug with notorious mental health harms. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults. In 1995 alone, college students reported more than 460,000 alcohol-related incidents of violence in the US. A 2011 prospective study found that dating abuse was associated with drinking among college students. A 2014 study found marijuana had clearly lower rates of associated domestic and partner violence. As pro-legalization comedian Bill Hicks remarked, imagine you are at a sporting event and some guy in front of you is screaming and picking a fight: is he high on marijuana or is he drunk on alcohol?

Reducing alcohol use in society will likely reduce violence; reducing violence means reducing trauma in society as a whole. When did we lose sight of ending violence as a way of preventing the cause of so many mental health problems? And legalization has already reduced traffic fatalities associated with drunk driving in states where it is legal – each traffic death sends out shockwaves of trauma and grief, and turns many people to alcohol or psychiatric drugs. (Hicks also said the biggest traffic danger from driving high is hitting the garage door because you forgot to open it.) Marijuana legalization is an upstream solution with huge implications. From a public health standpoint there is really no argument: if we can bring alcohol use down in society, then marijuana legalization is clearly worth it. According to the Centers for Disease Control, abuse of prescription opioids such as Oxy-Contin and Vicodin is a national epidemic that kill 16,000 people annually and devastate lives and families. Cannabis legalization could also reduce the market and illegal demand for opiods, easing this epidemic.

Legalization of cannabis also has important implications for young people and families – once we understand the complexity of substance use. The War on Drugs has devastated the US black community, and it is shameful that white-dominated mental health organizations have not spoken up against prohibition. Prison and the police are a traumatizing factor that directly interfere with mental health recovery. While legalization, according to the Journal of Adolescent Health, has not led to an increase in teen marijuana use, it does give families and youth more flexibility. For young people using cannabis, it might be more realistic to switch the kind of cannabis they are using as a harm reduction approach, rather than giving cannabis up completely. Many young people are committed to cannabis as a lifestyle, a form of religious expression, and a pathway to independence. Under prohibition it is impossible to talk openly about their cannabis experiences, and difficult to differentiate cannabis strains they are consuming. It may be easier for a teen to hear “use CBD strains, not the THC strains” than for them to hear “you have to stop smoking entirely;” “You can smoke pot, but in moderation” might work better than “you can’t get high at all.”

A harm reduction perspective is best served by legalization. Collaborative relationships require honesty: young people today know that different strains do different things, and they know the hypocrisy of a War On Drugs that sends people to jail for smoking a joint and then sells their lawyer whiskey at the bar next to the courthouse. Overgeneralized associations between marijuana and mental health problems, including psychosis, ignore a complex reality.

Adolescents using marijuana who get into emotional and psychological difficulties are like any adolescents who get into emotional and psychological difficulties, for whatever reason. They need help and support. The family needs help and support. The problem is never “marijuana plus genetics equals psychotic disorder.” The marijuana may, or may not, be part of the problem. When families — and doctors —are blaming the marijuana it is usually a sign of a deeper problem being avoided. Prohibition is based on fear, the same fear behind the search for a simplistic answer, something to grab ahold of as the solution in a situation that feels out of control.

Cannabis use then often becomes a power struggle in families. As a therapist I have seen time and time again families where a son or daughter has been psychotic after using marijuana, and the family’s response is to ban their son or daughter from using. So what does the young person do? They keep smoking, of course, except now they have a new problem: hiding from the parents, a power struggle with their parents, and the beginning of a cycle of isolation if the power struggle continues. I have to work hard to stay in a trusting relationship with both sides, and that job gets harder the more prohibition fear entrenches intolerance. The solution is to create conversations about the substance; even if the parents are strongly against any marijuana use, it’s important to respect all sides, but on an equal playing fiend where the young person can be validated for a choice that has some science on its side. Dismissing one side doesn’t help. Doesn’t it make more sense to say Let’s talk? than to Just Say No?

I have no doubt that marijuana use has played a role in many people’s problems with psychosis. I routinely work with people to encourage them to stop smoking when they know it can lead to crisis. I’ve seen people off marijuana start using again and end up hospitalized. And marijuana can certainly lead to habituation for some people and play a role in substance problems. Educating society about these risks makes the same sense that educating society about alcohol risks makes sense – as long as the risks are not exaggerated. Personally I would like to see cannabis avoid the commercialization of alcohol and be a more accepted – but not promoted or advertised – personal option. We really don’t need any more consumerism than we already have. Instead, we need an honesty and smart use that we really don’t even have with alcohol, with all the alcohol advertising and the culture of happy hour and spring break.

And of the risks, what about the correlation between first break psychosis with a higher rate of marijuana use? There is in my view validity to that concern — and it also be at least in part misleading. What if the causality is sometimes in the other direction? What if people who end up psychotic are drawn to altered states of consciousness in general, what if they first seek out in marijuana what they eventually end up later seeking in their break to a psychotic reality? Working with young people over many years, I see the need to get “high” comes first, not after, the substance. Few families have honest discussions about the need to get high and get away – how it is a human need that everyone has. And getting high repeatedly may be an escape hatch out of untenable life circumstances and confusing options. Maybe a young person is drawn to cannabis by the same inner need that will eventually draw them to psychosis, correlating the two – but not indicating causality.

As we come to terms with the devastating impact that psychiatric drugs have on society, we face a compelling question: What if there was a substitute? Someone considering a benzo, or an anti-psychotic, or an anti-depressant, is about to embark on a risky treatment option that might work out fine, or might end up destroying their life. That is the reality of the risks of psychiatric drugs. The Soteria House alternative and the Open Dialogue approach, it should be remembered, do rely on psychiatric drugs as a last resort. What if everyone had, on a wide scale, the option of choosing something with a lower side effect profile, and perhaps thereby could be diverted from a risky pathway? That may be what the US is on the brink of with legalization. And what exactly do we know of Pharma’s influence in opposing marijuana legalization? The American Medical Association and APA have long opposed legalization; does medical cannabis represent a threat to Pharma markets?

These social implications have not gone unnoticed by the web of financial interests benefitting from cannabis prohibition. The same public policy corruption driving psychiatric drug use is also evident in efforts to block legalization. Dr. Herbert Kleber of Columbia University, an impeccably credentialed academic, is widely quoted in the press warning against marijuana – and also serves as a paid consultant to leading prescription drug companies. Oxy-Contin manufacturer Purdue Pharma and Vicodin manufacturer Abbott Laboratories are among the leading funders of the Community Anti-Drug Coalition of America and Partnership for Drug Free Kids – both  fierce prohibition advocates. (Other funders include Janssen and Pfizer.) When Patrick Kennedy’s so-called Project SAM (Smart Approaches to Marijuana) worked against Alaska’s legalization initiative, activists counterattacked by pointing out the organizations extensive  financial ties to the liquor and beer lobby. Dr. Stuart Gitlow, President of the American Society Of Addiction Medicine, another legalization opponent, went on the media circuit disputing President Obama’s statement that marijuana is no more dangerous than alcohol: Gitlow serves as medical director for pharma company Orexo, an opioid manufacturer. Former Drug Enforcement Administration head Peter Bensinger and former White House drug czar Robert DuPont (yes that was his title) now run a commercial firm that specializes in the market for workplace drug testing.

While some police have come out against the War on Drugs, many police are lobbying in favor of it. Is it because they receive millions in funds to use under drug money seizure and assets forfeiture laws? One Florida sheriff who led opposition to legalization went so far as to state openly that drug asset forfeitures were important for county law enforcement resources. California legalization was opposed by another police lobbyist who made a career of funneling federal War on Drugs grants to state law enforcement. This is corruption in the crudest form: a mandate for serving public good diverted to individual gain.

As Los Angeles Police Department Deputy Chief Stephen Downing told The Nation, “The only difference now compared to the times of alcohol prohibition is that, in the times of alcohol prohibition, law enforcement—the police and judges—got their money in brown paper bags. Today, they get their money through legitimate, systematic programs run by the federal government. That’s why they’re using their lobbying organizations to fight every reform.” Legalization means challenging economies of influence and politics of corruption that have made drug policy and criminalization big business. Importantly, ending alcohol Prohibition in 1933 involved a vast clearing out of this corruption from the federal to the local level; hopefully the grassroots drive for cannabis policy reform will likewise have wide anti-corruption implications.

Even when we support cautious consideration and avoid making any blanket endorsement, cannabis is a powerful psychoactive plant that involves risks. Small controlled doses – a few drops of tincture, a small puff from a cigarette, a single edible candy – are still unpredictable, and might launch someone onto an unpleasant altered state, make working or relating in public difficult, trigger insomnia, interfere with driving, set someone down a path to addiction, or worse. Harms to memory and cognition development among adolescents might reveal themselves after long term heavy use. There are risks: it’s not a one size fits all solution. It will take some time to sort out studies and research honestly and get a realistic sense of the social impact in the wake of a politicized and corrupted research legacy.

And this underscores one of the central problems with the cannabis policy discussion. Legalization activists wisely chose to emphasize medical uses on a pathway towards greater marijuana acceptance. But in practice, as a plant medicine, cannabis has never been and probably never will be a targeted medical treatment. It is a plant, not a pill. Cannabis is a choice to introduce a substance into one’s body that will have unique and unpredictable effects on consciousness. It’s a life decision. It changes you, in subtle ways or dramatic ways, to ingest a substance.

Like regularly taking alcohol, drinking coffee daily, smoking cigarettes, and the use of food and herbal medicines in traditional cultures, marijuana is really best understood as a relationship. The human body and mind have receptors uniquely designed to interact with cannabis, which helps explain the broad range of consciousness and physical health effects now bing studied and experienced. Specific uses and strains might target symptoms associated with a diagnosis, but cannabis is not like penicillin. Only the individual knows how perception and consciousness are altered, and whether that is experienced as a plus or a minus in life. Some people will choose to be high if it goes along with reduction of some other discomfort; others will prefer to avoid getting high in any form. From food to movies to wine to sexuality, “self-medicating” is after all a widespread social practice and should be acknowledged: we all, to some degree, medicate ourselves just as we all, to some degree, get high. And this is what we have overlooked in our understanding of psychiatric drugs – they too are very powerful mind altering substances that get us “high.” It’s not what we think of as a high, we are still altered when we take our Zyprexa or our Prozac, and some psychiatric drugs, such as the benzodiazepines and the stimulants, are widely used recreationally. The psychiatric drugs have clear toxicities to the body; cannabis has extremely few, and a wide profile of benefits. That’s why it’s been used around the world as medicine since prehistoric times. It is also mind altering, despite the emphasis on “medical” use, and we need to recognize that altering our minds is part of what we do as humans.

We need the freedom, especially when we are facing extreme distress and crisis, to choose what risks we want to take and what substances we want to introduce, or not introduce, into our bodies and minds. We are bombarded by physical and psychological stresses in virtually every aspect of our lives today. Some of us choose alcohol, Some of us choose yoga, running, and organic food. Some us will choose cannabis. We need to take a principled and ethical look at that choice, and we need to ensure that people exploring this option aren’t put in jail for it.

Journey Through Mania | Oryx Cohen

Sat, 08/29/2015 - 17:31

Psychiatric survivor leader Oryx Cohen was at a national conference when a seizure suddenly launched him out of his body and into a visionary state of madness. Avoiding medications or hospitalization, friends held a hotel room vigil for Oryx for many sleepless nights, and then drove him 4 days across country to safety.

What surprising lessons – about the usefulness of medications, support, spirituality, and his own trauma – did Oryx learn? How can the fear of manic psychosis turn into healing?

Thinking Upstream: Winning Real Mental Health Reform By Joining the Anti-Corruption Movement

Fri, 06/12/2015 - 14:12

At the end of my talk at the American Psychiatric Association Institute on Psychiatric Services, a psychiatrist in the crowded lecture room put his hand up and posed a surprising challenge: Why was I so concerned about reforming psychiatry and ending iatrogenic harm from medications, diagnosis, and forced treatment when there are so many other issues in society to worry about?

Looking back, the answer was obvious: because psychiatry harmed me personally, and because I saw so many others harmed (including both of my parents), I was inspired to make a difference. I wanted to share what I learned so other people wouldn’t go through what I went through. Like many people who endured injustice personally, I was motivated to do something about it.

An obvious reply now, but not the reply I gave at the time.

Instead, I said to everyone off the top of my head, “I agree, I think we all should be concerned about every issue!” The room burst into laughter, and then I explained that I took his point seriously. The Madness Radio program I host has done shows on many topics including poverty, homelessness, elder care, the environment, birthing, and police, and organizations I’ve been part of, including Freedom Center and The Icarus Project, of have taken multi-issue approaches. My talk at the Alternatives Conference urged us to bring issues together, including discussion of the prison industry, the war on drugs, and the harm to the Black community by our biased criminal justice system.

After all, everyone is concerned about many social problems: even psychiatrists and psychiatric survivors think about issues beyond mental health. We are not single-issue by nature. We worry about affording dental care, we worry about endless wars, about the coming generations growing up in a world of ecological extinction, about the financial system, homelessness, climate change, student debt, the disappearing middle class, and children in poverty. We all worry about these things, but we just choose to narrow our focus onto manageable areas of life where we believe can make a difference. Going smaller, going single issue, seems more realistic. Sometimes that means a career in a field, sometimes that means a role in a movement, sometimes a mixture of both.

I think we’ve got it backwards though. Going smaller and single issue isn’t the way to be effective — going small means we won’t be effective, even in our small single issue.

I was inspired to read Robert Whitaker’s latest research into psychiatry and institutional corruption because Whitaker is taking us in a direction that will inevitably leads to multi-issue organizing and away from single issue. Not by adding concerns and causes on top of concerns and causes, nor by scattering our energies where they should be focused, or just creating laundry lists of change we’d like to see. Instead, as Whitaker and Lisa Cosgrove’s new book points towards, seeing things from a multi-issue prospective is the inevitable conclusion you come to when you follow the money trail of what it will take to actually achieve the institutional reforms of mental health care that we are all reaching for. Corruption of our political system has to end if we are going to provide meaningful mental healthcare to people. Because no other effort, no matter how innovative or appealing, will succeed without the rules of the game being changed, and those rules affect all the issues.

Over 13 years I have sat in many hundreds of support groups, workshops, and events talking with many hundreds if not thousands of people who have been psychiatric patients, on medications, and hospitals. People speak of their lives first and foremost as people. Mental health is about human suffering, and human suffering does not limit itself to a single issue. We may advocate for a better standard of psychiatric care, but often that narrows what someone truly needs for wellness in their whole lives. The well documented intersections of mental health and poverty clearly illustrate this, but we should also consider the roots of mental distress in violence, isolation, and consumerism.

Most of the case managers, social workers, peer specialists and counselors that I meet with and do trainings for recognize this immediately. Aren’t most of the people we work with, I ask, really facing the problem of poverty in our society? Don’t homelessness, the criminal justice system, child abuse, lack of jobs with adequate pay, lack of funding for substance abuse programs — aren’t these the issues we see on a day to day basis when we talk with people diagnosed with a mental disorder? Aren’t these the “stressors” we know that turn coping day to day into collapse and crisis? And among those who are more middle class and privileged, isn’t there a terrible stress around lack of adequate childcare, a heavy consumer and student debt, a scramble to keep up with 60 hour work weeks, a despair about the future in a world of ecological extinction, fear of falling behind, substance problems, failure to prevent or heal child abuse, and a media-saturated and materialist world that seems to have no real space to be human?

When we sit and listen to people we find a society in crisis from multiple issues, a crisis that is affecting everyone. The enormous popularity of the short-lived Occupy movement showed that ordinary people in the US are deeply affected by the decline of the middle class and growing economic insecurity. Many of us watched our pensions and retirement savings suddenly shrink in the 2008 economic crisis. And if you talk with people, all this plays directly into mental health diagnosis and recovery.

What will it take to establish a new standard of care in mental health? A standard of care that serves recovery, avoids iatrogenic harm, keeps people off disability payments, saves money, embodies humanistic values, is preventive, and responds to consumer needs? And what will it take to actually lift people above the suffering that drives mental health crisis? To actually create a society that not only responds to crisis well downstream, but prevents the causes of crisis upstream?

So when we look deeply at people with psych diagnoses facing mental health problems, we find human beings living in a society that has problems that are multi-issue. But then of course we say, Well we can’t address everything, so let’s at least try to focus on the outrageous harm from psychiatry itself, and at least make a difference on that specific area of our lives.  It’s manageable. We can’t tackle everything. We have lived experience or professional training that makes us experts in the single issue. And especially since we’ve now got some momentum – there is more credence to non-medication approaches, the influence of pharma corruption is under greater scrutiny, and the faulty science is finally coming to greater light, some alternatives are being funded (sort of). We can’t address everything, so go more single issue around mental health and keep it smaller.

But, it turns out, as Whitaker, Cosgrove, and others are now starting to suggest (including Lawrence Lessig — who wrote the preface to the new Whitaker book — and his colleagues in the growing “anti-corruption movement”), not only when we listen deeply to people do we discover multiple issues behind their mental distress, but when we look deeply at psychiatry itself, we find that the very solution to the “single issue” of mental health reform necessarily brings in all the social issues.

Just follow the money.

As Whitaker is pointing out, psychiatry harms people despite being dedicated to helping people, because economies of influence create incentives for psychiatry to act in a way antithetical to psychiatry’s public mission. If you want to reform psychiatry, you have to change those economies of influence. And you have to change the rules of the money game that are creating those incentives. Pharma creates payoffs for psychiatrists to embrace a disease model that markets drugs, and in turn enhances the marketing power of the doctors who prescribe the drugs. When problems are framed as diseases to be cured with pills then more consumers will turn to the prescribers. Sickness becomes a commodity and the more illness the more incentive.

This corrupt economy of influence means money will flow into science to twist it to back the model that serves pharmaceutical and professional interests, even at the expense of honest research. (Marcia Angell, former Editor-In-Chief of the prestigious New England Journal of Medicine, writes what is now widely known: “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”) The entire industry takes in money for its mutual enrichment, and the public trust of science and human needs is broken. As Whitaker notes, this economy of influence and the rules of the game it plays by is properly named institutional corruption. Not backroom payoffs to “bad apples” breaking-the-rules-kind of corruption (though that happens too, and just results in court battles and fines that Pharma covers as a cost of doing business), but out-in-the-open corruption — legal corruption:  funding through lobbyists, research money, payoffs to researchers, bribery of leading advocacy and lobby groups like NAMI and MHA, a revolving door of legislators, regulators and the industries they should be overseeing. A corrupt – but legal – economy of influence.

And why, we ask, was pharma allowed to corrupt the public trust of mental health care and science so thoroughly? Where is the regulatory apparatus that protects the public from such corruption? Where is congress? Where is oversight as this unfolded? And the answer is very clear – the governmental regulatory apparatus that should be overseeing the public trust and that could be counted on to curb these social harms is under the same system of corrupt economy of influence. The democratic bodies of accountability that might have stepped in and prevented the moneymaking incentives for psychiatry’s social harms have themselves come under the influence of the same moneymaking influence. Both parties, Democrat and Republican — just follow the money. The founding fathers of the US democracy said that government shall be accountable to the people, yet that accountability no longer exists today. Government is accountable to money.

(We see the same pattern in the financial crisis that nearly toppled the world economy and led to an unprecedented bailout of banks, a return to business as usual, and zero prosecution of any of those responsible. The financial sector dismantled regulation, created financial high risk  super profit products that cause social harm and destabilzed global markets in a speculative bubble, finally threw the entire system into crisis — and the financial sector had already captured the regulators that might step in and fix things.)

Pharma spent $2.6 billion on lobbying activities from 1998 through 2012. Oil and gas companies spent $1.4 billion lobbying Congress over the same time frame while the defense and aerospace industry spent $662 million. Yes, an industry with that much influence will shape the whole society in its image. That is why so many people are on psych drugs today. When the rules of the game allow it to, pharma has every rational economic reason to seek maximum profit by turning the entire society into a prescription pad, which it has effectively done over the past thirty years. That is the reason psychiatry continues its social harm: there is clear financial incentive for the government to play along with the rigging of the rules of the game against fairness and honesty. If you want to understand politics, you just need to follow the money.

The power of lobbying and the power of money in politics. The revolving door, the fact that if you want to predict who will win any election just look at who raises the most money, the secret donors swaying election results, the obscene Koch brother legal bribery that is just the tip of the iceberg of political process sold to monied interests, with Citizens United only the latest excess. We are all aware of this to some degree.

But we’ve sort of stepped to the side of it all, in the name of focusing on our manageable, smaller single issue. And now here we find it — at the very center of our concern for mental health reform.

We even have stories of bright examples in the past – Soteria for example, or the promise of the early “recovery” and now “peer” movements – being co-opted and twisted when they are up against the power of this institutional corruption. And so this is the key: the corrupt economy of influence that drives psychiatry’s social harms is a normative economy of influence for every policy issue in the US today, because the entire US policymaking system is based on corrupt economies of influence. Psychiatry’s corruption is just a single example of the standard operating incentive structure of every aspect of our national politics.

As I write this I am becoming emotional. My compassion goes out to everyone that I meet and work with, everyone I listen to and learn from. Each of us is suffering and struggling with the large social issues of our time. I am not talking about left or right here, Democrat or Republic, tea party or anarchist, I am talking about human suffering. I am talking about how hard it is to get childcare, how working families are under extraordinary stress, how it is hard to look at a child today and feel joy when you know the world they are growing into will be a post-mass extinction world. My deepest passion is to meet human suffering in the most ethical and honest way that I can, and my focus on mental health has been a way to use my own personal experience for the social good.

And now I see clearly that if we truly care about each other as suffering human beings — which is what “mental health” is really about— we have to challenge the broader institutional corruption of our society as a whole. I have always sought to bring issues together, and always spoken out for a multi-issue perspective. Now the “anti-corruption” framework of “get money out of politics” articulates a clear imperative. And Whitaker’s new book points to the same inevitable conclusion. Not to add issue on top of issue, but to recognize that no meaningful and widespread mental health reform can ever be achieved as long as the broader corruption remains, broader corruption which affects all issues.

And I struggle to make this clear, to convey it succinctly, and convincingly. I can’t summarize or persuade you of the pressing social issues of our time: child poverty, climate change, species extinction, homelessness, violence, the prison system, the disappearing middle class, endless war, financial giveaways to those responsible for financial crisis. But I want to say that those on the right, Republicans and tea party activists, share a human need to have our social concerns addressed, and that is just as impossible for the right as it is for the left under the corrupt political economy of influence in the US today. Right wing thinkers are waking up the corrupting influence of moneyed special interests in our democracy as well. I am not pitching a mental health reform movement that just joins a broader left. And this is very significant, because the “left-right,” Democrat/Republican, Red state Blue state divide in our country is an image of the corruption itself. The Democrats are just as much a part of this problem – they thrive on it as well. The Red state Blue State divide talk obscures the many common concerns and interests that people have when you look at public opinion polls – commonalities that are obscured by the corrupt economies of influence that capture both sides of the political aisle.

Public opinion polls show broad and overwhelming support for the framework of “get money out of politics” and “end institutional corruption” regardless of political orientation. According to the Pew Research Center, public trust in government, from the left and the right, is at near record lows; shockingly, 50 percent lower than immediately after Watergate. Another poll shows about 81 percent of people surveyed said the current campaign spending rules are “bad for democracy.’ 81 percent – Red state, Blue state. Yet like other broadly supported issues, that doesn’t translate into policy – because of the corrupt economy of influence.

So please take this essay as an invitation to think and research and discover. I don’t have the answers, I don’t have a grand strategy or solution. But I do know this: We have to start talking about getting money out of politics – not just to win real reforms of psychiatry but for all social concerns. We may not know exactly how to do that, but no real mental health reform will be possible when the political system is sold to monied interests invested in preventing reform. It just is not going to happen. Some of us continue to push for our single issue, but where are those who are asking for a winning strategy? I personally am not interesting in pushing for change, calling for change, advocating for change. I want the change to actually happen.

Getting money out of politics is the only way to end the corrupt economies of influence driving the social harm of psychiatry. When I talk with people involved in mental health advocacy, they are inspired. Then we talk about corruption of politics by money and how that creates a real bottleneck for true change. They become despairing, cynical, fatalistic. That won’t change. So we have to focus on our single issue area. But if we are honest, we see that is no longer viable – our single issue will never succeed without he larger upstream problem being addressed.

We tend to separate reforming the standard of care for mental health from the problems with the health care system as a whole for example. But seen from the standpoint of institutional corruption, they are the same. As are the issues of climate change, a living wage, a financial sector that won’t keep blowing up, a fair and just police and prison system. How many times have we heard that the US delivers terrible healthcare for the highest cost? How many times have we been told there is not enough money, or no insurance billing, for alternatives? Follow the money and the same picture emerges.

The story of Medicare Part D is just one example. In 2006 US political leadership under heavy pharmaceutical lobbying and campaign contribution influence — under the corrupt economy of incentives that is standard — passed a Medicare law that prohibited the government from negotiating drug prices. (Now bear with me here, because I realize some of you may be saying “We don’t want cheaper psychiatric drugs.” I hope this broader discussion will show the pointlessness of narrow single issue downstream thinking when the upstream cause is what is important.) The Veterans Administration already set a precedent for negotiating prices, but Medicare now could not. Pharma profits rose 33%! From a single legislative act! And the congressperson who wrote Part D went to work as lobbyist for pharma with a $2 million salary. Obama campaigned strongly against this giveaway to the pill companies, and it was estimated his proposal to reform Medicare Part D could save the country $137 billion over 10 years. But Obama too operates under the rules of the corrupt economies of influence, and so $69.6 million in Pharma lobbying meant that Obama broke his promise to end Medicare Part D. Publicly broke a promise at the center of his flagship issue, healthcare reform.

That is how much power the rigged rules of the game have: they routinely overwhelm even explicit campaign promises and commitments at the highest levels. No vision of humane, honest mental health treatment can stand up to that kind of corruption. It just won’t happen.

Currently our strategies look like this: speak out and change public opinion. Engage as Jim Gottstein has written about, in strategic litigation, and build viable alternatives such as peer respites and medication alternatives to point the way to the future.

None of that will succeed unless the more upstream issue of institutional corruption is addressed. The Medicare Part D issue is instructive: it was at the top of so many people’s agendas  and makes perfect logical sense. It was under huge public scrutiny. And it was a corruption of healthcare priorities pure and simple. And still reform was not effective because the incentive structure of corruption was too powerful.

The reality is that we rely on changing public opinion to make change. That is the assumption – get the word out, wake people up, get people on our side. Publicize research showing that alternatives to the medical model work. Convince through great investigative journalism. Appeal to conscience by speaking from lived experience. Reach people. A pluralist assumption – change opinion and it changes policy. Attitudes will shift and there will be a gradual change of society. Right? Sadly, no. That assumes that public opinion and attitudes drive political policy in the US, that the views of ordinary people shape social issues. But people don’t. Money does. There is no pluralist democracy in the US. Activism and education on the assumption of pluralist democracy will fail.

This has been demonstrated again and again if you look beyond the “wedge issues” that distract us so often from real issues and have become the spectator sports of election time. This is clear if you go beyond the single issue, lesser-of-evil logic that leads so many to vote single issue and mocks the very concept of democracy expressing the will of the people. Opinion polls consistently show wide support for issues that never get support on the policy legislative level. While a clear majority of 1% super rich favor cuts in Medicare, education and highways to reduce budget deficits, only about a quarter of the rest of the population agree. Eighty-seven percent of the general population agree that “government should spend what is necessary to ensure all children have good public schools;” while only 35 percent of the super rich share that sentiment. And 53 percent of regular people believe that “government should provide jobs to everyone who can’t find one in the private sector,” while only eight percent of the super rich agree. By overwhelming margins, Americans favor raising the minimum wage, reducing wealth and income inequality, stopping any more NAFTA-style trade agreements, breaking up giant banks, investing in infrastructure, taking measures to avert catastrophic climate change, protecting and expanding Social Security and Medicare. Those are strong public sentiments for humane policies — despite a barrage of media messages pushing these views out of the realm of the thinkable.

But this public opinion doesn’t translate into public policy — money does.

In fact Princeton researchers Martin Gilens and Benjamin I. Page did a careful study (“Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens,” in Perspectives on Politics) looking at who’s opinions actually shape government policy. Using careful analysis of data that the showed that it is money, not people, who run our democracy. They looked at 1,800 different policy initiatives from 1981 to 2002 and concluded that “The central point that emerges from our research is that economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy while mass-based interest groups and average citizens have little or no independent influence.” They found that when controlling for the power of economic elites and organized interest groups, the influence of ordinary Americans registers at a “non-significant, near-zero level.”

Average citizens – the ones we hope to change the opinions of – have little or no independent influence on government policy. Non-significant. Near-zero.

Personally I have not voted in every election. Voter turnout in the US is very low (in 2014, only 36 percent of eligible voters turned out for the midterm elections. 36 percent) . But when you look at the facts – that ordinary people’s votes don’t really make a difference, it is money that makes a difference — who is more “apathetic?” Someone who votes in a system they won’t actually influence, or someone who votes with their feet against that system by not voting? And many of those non-voters do know, if you ask them, that the game is rigged.

I’m not arguing against voting. But Lawrence Lessig summed it up. There are two elections. The first election is by money. The 1% sets the agenda for this election. Then you and I step in with our vote – once the real election has happened. It is a modern form of what Lessig calls “Tweedism” after the New York corrupt politician Boss Tweed. Tweed said, “I don’t care who does the electing, so long as I get to do the nominating.”

It’s a time honored racket to keep democracy out of the hands of the people, and it continues today. In the Jim Crow south a similar corruption kept racism in place: the “white primary” where only whites did the nominating of candidates, then the general election where Blacks were (nominally) included. Today we have the same – a “money primary” where all the issues and candidates are determined, and then the vote for the rest of us. Isn’t that why, again and again, there is no real candidate supporting an alternative to the medical model of mental illness – despite huge public support for holistic healthcare and huge skepticism of pharmaceutical companies and psychiatrists? Isn’t that why we are reduced to ridiculous “lesser of evil” calculations for our vote that go nowhere? It is because pharma already did the nominating – ensuring that both sides of the aisle were pro-pharma.

I am all for alternatives and for hopeful initiatives. I love to see reforms moving forward. I do them myself. But philanthropy is no solution to the economy of influence, it is moneyed influence in its purest form. I am inspired by the rise of large scale philanthropy around mental health reform that Whitaker’s research (and the failure of the mainstream standard of care) has helped inspire, and excited to see small changes and more open minds among wealthy patrons leading to good causes getting funded. But if we are honest, rather than just career reformers content with endlessly calling for change, none of it will succeed if the upstream issue of corruption of our political system remains unresolved. Philanthropy isn’t just explicitly anti-democratic, it is a reversion to monarchy. A few philanthropists are joining the movement against corruption and the upstream problems, including some in the tech sector who have been following Lessig’s work, and this is good. But philanthropy, because it is pure influence by money, becomes the very gatekeeper that is the problem within the economy of influence itself. We are now beholden to our rich funders rather than county and state contracts, but we are still beholden, and the result is the same: we are now driven to remain single issue, and now this issue becomes the focus and not that one (notice how medications, not trauma and forced treatment, are more and more at the fore in our movement?), we can go and talk so far but not too far, mental health innovations but not multi-issue thinking, downstream focus but not upstream solutions.

Who is talking about preventing child abuse in the first place? Isn’t that a way to deal with mental distress – by preventing it? Why is that issue not part of the broader mental health reform agenda? Do gatekeepers keep the issues separate despite common sense bringing them all together?

Again and again I see this when I give talks and trainings. People working in publicly funded agencies are the same as people working in philanthropically funded organizations. If you talk with them individually they embrace a multi-issue view and agree with getting money out of politics. They get it. I get cheers and applause at my talks. But the work they do publicly? It’s beholden to the language of their funders and contracts, and limited to narrow agendas. They are held back by the same gatekeeping dynamic of the corrupt economies of influence as a whole. Lessig calls this “dependency corruption” — you don’t go against the implicit agenda of your funders or whoever gives you access. You don’t bite the hand that feeds you or the patrons that open doors for you. So as much as I respect the good small single issue work of my colleagues – and I do this work myself — it is a dead end. Just follow the money and ask yourself: what is truly needed to make real mental health reform happen in the US? Real change that will really help people? Reforms are impossible without reforming the rules of the game itself.

There is currently no established mental health advocacy organization that is actually addressing what it will take to get not only meaningful mental health reform but any social policy reform. There is no established mental health advocacy organization that is raising the question of the corruption of our democratic policy making system by monied interests. There is no mental health advocacy group that is joining with other organizations in the society and addressing the upstream issue of political corruption. None. And that needs to change

The only organization I can think of that comes close is The Icarus Project, where I was co-coordinator for many years. At Icarus political reform discussions are routinely woven into discussions of mental health reform and mental health activism is woven with social justice activism in general. But the corruption issue is broader than the left, and Occupy burned itself out on failure to focus. We need a clear focus people can relate to across the false Red state Blue state spectacle that falsely divides us.

Charlotte Hill of the anti-corruption group Represent.US writes “The one-sided nature of many past ‘money out of politics’ campaigns left them vulnerable to opposition attacks painting them as pet projects of liberals intent on shutting down their opponent’s financial support. If we want to avoid a similar fate, we need to call out corrupt behavior regardless of party affiliation, and make it clear that we believe it should be illegal for anyone to use money to purchase political influence.”

I’ve been writing and speaking about multi-issue advocacy for many years, and have begun writing and speaking about institutional corruption of the democratic system and the comprehensive reforms needed to get money out of politics. When I’ve made speeches and shared info about the prison industrial system or Lessig’s work, the response from movement leadership has often been that I am changing the subject, or going off topic, or they are personally glad to hear it but won’t bring it into their daily work agendas. It hasn’t been picked up. But I think this is changing. Whitaker’s new book asks the right questions and points in the right direction.

I’ve already made a personal commitment that I will no longer be speaking as a mental health advocate without also speaking as an anti-corruption advocate. It’s just not honest – calling for something that’s impossible without bigger, upstream reforms. Not as a way of “adding on” new issues. Not as a way of pushing a liberal or left agenda against the right. But as a way of being realistic about what it will take to achieve mental health reform itself: it won’t happen unless the rules of the game are changed.

I am a learner and I am a researcher about this. I’m expanding my thinking and broadening the scope of my awareness. I have begun to find organizations, writers, campaigns and projects that form the broader anti-corruption movement in the US and abroad (because yes, many of our international colleagues are coming to the same conclusions – most much faster than we in the US, especially after devastating economic crisis in Greece and Spain make it impossible to think of any reform without rules of the game reform). I’m not beholden to any specific organization and I am not writing a grant proposal to go solicit funds for some new project. This is about what my heart says needs to happen for us as a society. What I am doing is reading books like Lessig’s Republic, Lost, and his other writing, joining some of the efforts of and, checking out the Sunlight Foundation and Public Citizen, signing up on sites like, speaking out about the Citizens United ruling, and learning about the American Anti-Corruption Act. I don’t know that these are ultimate solutions, and my thinking is evolving, but I do believe these are in the direction we need to go in. Organizations are always interested in self-preservation, and many of these campaigns have a “we’re doing great work, support us” emphasis where I prefer coalitions and broad discussion communities. So perhaps my directions will shift as I learn more about the issues and find out more about organizations and individuals working on them. But I do know that we as a society – and as a species even – are facing extraordinary social crisis rooted in an out of control political system corrupted by money. We need a fully human response. We need to think upstream. And above all, we need action that has a real chance of winning, not single issue action that fails to address the corrupt economies of influence that have sold our politics in the US and around the world.

Deep electoral system reform is possible. In the 19th century most balloting was public, which led to massive corruption and bribery of voters. That was changed to secret ballots as the result of state by state reform movements in the 1890s. The New Deal dramatically reformed out economic system. The American Anti-Corruption Act is one possible reform direction to deal with bribery of candidates. It would make it illegal for politicians to fundraise from interests they regulate, ban lobbyists from offering elected officials lucrative jobs after they leave office, and create a system of citizen-funded elections to make it possible to run for office without selling out. The Act would also provide for public campaign financing that would put ideas and people, not bribery, at the center of candidacies. New York City, for example, has public electoral campaign funding and much more diverse political spectrum to vote from. In Maine the Clean Elections Act dramatically increased accountability and reduced corruption and could lead to other states headed in the same direction (the Act is under challenge by a push back from the courts, leading proponents to mount a defense to get it re-established). Efforts are growing against the Citizen United ruling, and to make visible the 90% of campaign donations that are “dark money” — unclear where it came from and hiding the influence of monied interests.

Does this seem like changing the subject and “adding on” new issues that will just distract us from the narrower agendas we should be focusing on? Or do we need to join efforts to end political corruption and get money out of politics or else we will never achieve the mental health reforms we are calling for?

Just follow the money.


Some possible links for further learning and action, an incomplete and imperfect list:,

Sunlight Foundation


Evolution of Mind | Maxine Sheets-Johnstone

Mon, 06/01/2015 - 17:05

Is thinking a cognitive process of information input and output? Or do consciousness and emotion take place in our bodies – animated, moving, and responsive to the environment? And does Darwin’s evolutionary theory see the focus on brains and neuroscience as based on a false understanding of what the human mind is?

Maxine Sheets-Johnstone, dancer, philosopher, and author of more than 70 journal articles and 9 books, including The Corporeal Turn: An Interdisciplinary Reader, The Primacy of Movement, and The Phenomenology Of Dance, explores her understanding of the evolution of mind.