Welcome to From Insults to Respect.
Recently I came upon an article in the October 2019 edition of the American Psychologist about using timeouts with children from 2 to 8 years of age. As a grandfather, it caught my attention.
According to the authors, Mark R. Dadds and Lucy A. Tully, the use of this technique is quite controversial. Well, it just so happens I love dealing with controversial issues. Though it often leads to some nasty insults flying my way, it gives me the opportunity to practice avoiding throwing insults back, and modeling a more respectful style.
The Controversy
What does this controversy look like? Well, let’s begin by looking at an article published in Time magazine titled, “Time Outs Are Hurting Your Child.” Here we learn from the authors, Daniel J. Siegel and Tina Payne Bryson, that:
“The problem is, children have a profound need for connection. Decades of research in attachment demonstrate that particularly in times of distress, we need to be near and be soothed by the people who care for us. But when children lose emotional control, parents often put them in their room or by themselves in the “naughty chair,” meaning that in this moment of emotional distress they have to suffer alone.”
Contrast this position with one expressed in an article published in the Washington Post titled, “Timeouts Get a Bad Rap, But They Work — When Used Correctly.” Its author, Camilo Ortiz wrote, in part:
“The effectiveness of timeouts has been proven through decades of research, including work in the field of “behavioral parent training,” in which professionals teach parents a set of effective techniques. These techniques — a combination of reinforcement of appropriate behavior, effective commands, timeouts and other consequences — are usually used with children who exhibit moderate to severe disruptive behavior, but they have also been shown to be effective with children demonstrating less severe behavior.
And a number of smaller, focused studies have specifically tested timeout and found it to be effective at reducing misbehavior in young children, typically ages 2 to 6. It also has been shown to be a more effective way of modifying behavior than physical discipline techniques, such as spanking. In fact, using timeouts as a tool to help parents set limits reduces the incidence of physical abuse by caregivers. And any alternative to physical discipline is a good thing. The American Academy of Pediatrics and the Centers for Disease Control and Prevention both support timeout as a best practice for behavior management in young children.”
Apparently, part of the controversy is due to the timeout technique being employed in different ways. Consider a parent who says she uses time out with her 5-year-old daughter. Then, when we watch her using the technique, we discover that whenever her daughter acts in any way that is annoying her, she begins to scream, shoves her into her room, while shouting, “You better shut-up you little brat!” She keeps her alone in her room for an hour.
Now consider another mother who says she uses timeouts with her 5-year-old son. This time, when we watch what she actually does, we see that she uses it along with a much larger set of discipline techniques that she learned from reading the manualized and evidence-based parenting program titled, The Incredible Years. 
Because she has a number of tools to teach her child to learn how to behave in effective ways, she only uses timeouts on rare occasions, lasting only 5 minutes, and targeting just one behavior during a period of a few weeks until her child has learned a new positive behavior pattern to replace the negative behavior pattern. Then, slowly, she incorporates the technique for teaching another behavior pattern. She never tells her child to stop doing the negative behavior pattern, but instead, she explains, as best that she can, what behavior pattern would be better, and explains why it would be better. 
When she sends her child to timeout, she does so in a calm, supportive voice, and remains in the same room with him. Prior to carrying out this approach, she has discussed with her child this technique, explaining that learning a new skill takes time, and timeout will help him to learn to act in a manner people will respect. She emphasizes throughout the process that she loves him, and expresses confidence that he will master the new skill soon.
So, here we see two parents believing they use timeouts with their child, but both use dramatically different approaches. I used timeouts with my two sons when they were very young in an even different way. I’ll describe this other approach shortly, but, for now, my main point in this section is that part of the controversy has to do with the fact that when people say they use timeouts, without finding out more details about how they use it, a great deal of misunderstanding can ensue.
Back to the American Psychology Article
Dadds and Tully, the authors of the American Psychologist article I mentioned at the beginning of this post, say that for them the definition of timeout is, “…a parenting strategy in which a child’s access to rewards, usually parental attention, is temporarily removed contingent upon a problem behavior and reinstated following a specified period of nonproblem behavior.”
Removing access to rewards is a type of punishment, and research on punishment indicates it leads to variable results, sometimes good, sometimes bad. Dadds and Tully appear to hope to mitigate any bad results by advocating that rather than using timeout as a stand alone strategy, its use “must be part of a broader behavior program that promotes a warm and rewarding relationship, and explicitly teaches alternative positive child behaviors to replace the problem behavior to improve the child’s self-efficacy in meeting their own needs.”
These authors, reviewing the research evidence, conclude that timeout, when used as they describe, can promote a child’s mental health and that there is an absence of evidence showing it is harmful after five decades of research. Meanwhile, inappropriate parental discipline strategies have been, and continue to be implemented in the name of “timeout,” and these are potentially harmful.
Now, before moving on, let me be clear that I am not disputing the research findings presented by Dadds and Tully. That said, my wife and I nevertheless used with our two sons when they were young a strategy that I viewed as timeout, but it differed in important ways from their approach. I think that difference is worth considering.
How I Used Timeouts
Like the authors in the American Psychologist article, I used timeouts as part of a broader child rearing strategy. However, unlike them, when I did use it, I did not seek to remove my child’s access to rewards, or any other type of punishment.
I have described my broader child rearing strategy in earlier posts (see HERE and HERE) Very briefly, it involved identifying what I wanted each of my two sons to do better and explaining to each of them why it would be better. If one or the other, did not succeed immediately in doing it just right, and began to resist, sometimes he would flare up in anger. When a situation of this kind occurred and he was all tense and excited, I would drop the subject and direct his attention to something else. Then, a little later on, I would bring it up again when he was in a calm mood. As likely as not, he would go over it now without any difficulty.
Another part of my strategy was, whenever possible, to teach my sons to improve their behaviors by focussing on the notion of a good. 
As William James, the great psychologist and philosopher, described using this approach with children:
Get them habitually to tell the truth, not so much through showing them the wickedness of lying as by arousing their enthusiasm for honor and veracity. Wean them from their native cruelty by imparting to them some of your own positive sympathy with an animal’s inner springs of joy.
We would celebrate success, rather than punish less than ideal behavior. And we had family meetings to discuss how we could improve how things were going in our home. My wife and I would first ask our sons what plan they suggest to solve a problem. Even if we thought the plan was less than perfect, we would often support giving it a try for a week. Then, if problems of the plan did occur, it would be discussed at the next meeting.
By using our sons’ plans as much as possible, they would be so intent on proving it can work, they would make it work despite flaws. As parents, our goals were to encourage our kids to understand that we were willing to listen to them, and we valued what they had to say. It was also important to us to foster in our boys sufficient self-efficacy in coming up with solutions that they could successfully implement, rather than always relying on authorities.
Finally, I am a big believer in teaching through stories. When an issue came up, I would either rely on a story I had heard, or make one up, designed to help them to consider better approaches to resolve certain problems. And I had both my boys read my three novels that have, embedded in their relatable narrative, a variety of issues regarding kindness and acting in ways that foster respect from others.
Now, because of these approaches, my wife does not recall using timeouts, and I rarely used it. When I would, it was not designed to teach them to improve their behavior. It occurred when someone nearby was having a hard time tolerating something one or both of my sons was doing.
For example, I might come home from work and my wife would say, “Jeff, could you get the kids away from me, I’m preparing dinner and they keep screaming.” So I would take them outside if it was nice out, or up to their room, while explaining, “Mom needs some quiet time.” Then when we would get to the quiet place, I would ask if they wanted some “quiet time” themselves, or did they want me to stay. They always said they wanted me to stay. We would then do something fun.
Note that in contrast to the American Psychologist article I discussed earlier, my use of this type of timeout was not intended to take away some valued reward. Rather, I would seek to do something pleasant with them. At some point, when all was calm, I would ask gently, “When you were making all that noise near Mom, had she asked you to quiet down?” I would then listen to their responses and gently ask what they could do better if a similar situation comes up in the future? When they were very young, sometimes they blamed someone other than themselves for what happened, and I would frown. Sometimes they responded in a manner that took responsibility for their actions, and I would say how much I appreciated what they had said.
As another example, when we were in a restaurant, if one of my boys began to make too much noise, I would take him outside, and explain that people who go to restaurants typically prefer to eat in a pleasantly quiet atmosphere. I would then explain that when he was ready to go back and speak softly we could enjoy a nice family meal together. Typically, in less than five minutes, we would be back at our table.
Now, what I just described, was the general discipline plan. That said, neither I, nor my wife always stuck perfectly to it. We did pretty good, but we both did lose our temper from time to time. When calm returned, I would say at a family meeting that I wished I had handled the situation better. I would also explain that sometimes even adults are not always perfect, and when I raised my voice in anger, if they thought it meant I don’t love them, actually I love them a whole lot.
Let me be crystal clear, I do not have any research evidence that suggests my approach is distinctly better than any of the others that uses timeout along with a broader discipline approach. All I can say for it is that it felt more right to me as I went through the period of my life when I parented on a daily basis, and though I’m obviously biased, as far as I’m concerned, both my boys, now in their thirties, turned out to be fine young men.
Well, there you have it, some thoughts on the controversy surrounding timeouts. I hope you find something helpful in some of the ideas that I shared, and please feel free to share your ideas with me and all of the followers of this blog.
Jeff
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
If they go to someone in the medical profession, they typically find that after a visit of somewhere between ten minutes to an hour they have been labeled as having a mental disorder and then are prescribed one of the psychiatric drugs, or even a whole cocktail of them. This pattern of dealing with such concerns leads, in some circles, to a conflict. Some involved in the conflict think that the pathologizing of these very human experiences and the encouraging of the use of drugs to manage them is the very opposite of a healthy approach. Meanwhile, other people feel that drug treatment for these types of concerns are enormously helpful, and anyone questioning this position is irresponsible. Insults have been known to fly back and forth from people on both sides of this conflict.
You can hear me, for free, being interviewed on this topic by the insightful Emily Whyte Rubin on a recently recorded Feeling Deeply podcast by clicking 
You see, when I look to see if someone has a conflict, I think of the word 
Being guilty, as I use the term, means the person would be deserving of some punishment, such as being insulted.
That’s not to say that I advocate that those people already taking these drugs should immediately stop taking them. There are some physiological withdrawal effects that occur if someone suddenly stops, which some experience as awful. If some of you who have been taking these drugs decide that you want to try to wean yourself off, a good resource to help can be accessed 
Although I don’t have a conflict with those who believe in the psychiatric medical approach, I do find that as I go about advocating for my own view on this issue, many with opposing views do end up having a conflict with me.
There are, however, other people who do support the psychiatric medical model, and yet, like me, treat people with opposing views respectfully. Today’s post comes out of one such respectful discussion. This person, without insulting me, defended his support of the psychiatric drugs by claiming that all of the research clearly indicates that the “antipsychotic” drugs, when used by people diagnosed as having schizophrenia, decrease the risk of dying. I then, very respectfully, asked that he supply me with the references that he is relying on to make his assertion, and within a very brief period, he did just that.
Prior to looking at the articles that the respectful criticizer of my position provided to defend his belief that the “antipsychotics” reduce mortality for people being treated for schizophrenia, let’s first look at some relevant research studies that he left out. You will note that each time I use the term “antipsychotics” I put it within quotation marks. This is to help remind readers that these drugs do not work like antibiotics, which are designed to kill bacteria that have infected an organism. Nor am I at all convinced that these drugs work to counter any of the causes that lead someone to be given a psychotic label.
Patients diagnosed as having schizophrenia have a 15-20 year shorter life expectancy than the general population, according to a 2014 study published in the Annual Review of Clinical Psychology titled “Excess Early Mortality in Schizophrenia.” Just in case there is any confusion of what “mortality” means, it means risk of death.
Adjusted for age and gender, people with schizophrenia taking either no “antipsychotic,” one, two and three or more antipsychotics had relative mortality risks of 1.29, 2.97, 3.21, and 6.83 respectively. Said in a simpler manner, individuals who were labelled as having schizophrenia who did not take any “antipsychotic” drugs had the least chance of dying during the 17-year follow-up period, compared to the other patients who were labeled as having schizophrenia but were taking “antipsychotics.” If the patients took just one of the “antipsychotic” drugs, they were more likely to die, and if they took more than one “antipsychotic” drug, they were even more likely to die. The association remained stable throughout the observation period.
The authors note that it has been claimed that the contemporary high natural mortality in schizophrenia results from a variety of lifestyle factors. Of these factors, the study that they did was able to consider several (smoking, exercise, body mass index, blood pressure, serum total and HDL cholesterol). After adjustment for these factors the excess mortality of people with schizophrenia persisted. The association with “antipsychotics” and mortality was, according to the authors, very clear.
Mental health services have advanced in many parts of the world during the past few decades. Apart from a different mix of community-based care, the introduction of the second-generation antipsychotic medications [also referred to as atypical antipsychotics] in the early 1990s was initially found to be associated with better quality of life and reduced risk of relapse.
During the 1970s through the 1990s, the authors note, mortality rates were improving for the general population. In contrast to this general trend, mortality of those classified as having schizophrenia was trending in the opposite direction. The median SMR for those diagnosed in the 1970s, 1980s, and 1990s were 1.84, 2.98, and 3.20, respectively. The higher the SMR, the higher the rate of mortality.
Adverse health outcomes associated with weight gain and/or metabolic syndrome (eg, myocardial infarction, cerebrovascular accidents, or cancer) may take decades to fully emerge. Thus, it seems likely that studies undertaken in the 1990s (ie, the most recent studies included in this review) would capture only a small fraction of the eventual burden of mortality associated with the adverse effect profile of the second-generation antipsychotic medications. In light of the rising secular trends in SMRs already identified by this review, the prospect of further increases in mortality risks for schizophrenia is alarming.
In 2009, another study looked at the relevant research, this one appearing in the journal Schizophrenia Research. Titled, “Influence of Antipsychotics On Mortality in Schizophrenia: Systematic Review,” it concluded, “There is some evidence that long-term exposure to antipsychotics increases mortality in schizophrenia. More rigorously designed, prospective studies are urgently needed.”
Also in 2009, there was a relevant study published in the prestigious New England Journal of Medicine. Titled, “
In 2010, the British Journal of Psychiatry published a study titled “Twenty-five Year Mortality of a Community Cohort with Schizophrenia.” Here, data from 1981 to 2006 was examined. The authors concluded that:
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.”
The first study on my critic’s list used 
Rather than supporting his position, this article supports the theory that given the evidence that the “antipsychotic” drugs have a number of serious side effects, and once started, physiological withdrawal effects can be awful, it is prudent to safely hold off on the use of these drugs for at least 13 weeks to see if some patients will begin to recover without them. Despite this evidence, I am under the impression from dialogues with many psychiatric patients that the standard practice is to prescribe these types of drugs within somewhere between 10 minutes to an hour after the patient is first brought to the attention of a prescribing doctor. 
Before moving on, I would like readers to note that this was the only randomized controlled study on my critic’s list of references that he said supports his position. The rest of the studies compared different groups of patients that were not randomly chosen to be in each of the groups. These studies compared a group of patients described as not taking “antipsychotics,” with others said to be either taking just one of them, more than one, different dosages of them, or another drug such as a benzodiazepine. Without random placement to each of the groups, these studies, from a scientific point of view, cannot speak to whether it was the prescribed drug that was the cause of the different rates of mortality, or other reasons. This is an essential point to keep in mind.
First, random assignment only increases the likelihood, but does not guarantee, that the different groups being compared will be so similar prior to any intervention that any difference found after the intervention is due solely to the different interventions each group does or does not receive. Thus, with random assignment the pre-intervention groups can end up quite different. When this happens, the researchers can end up attributing any difference between the groups after the intervention to the intervention when the difference might be due to the groups being poorly matched prior to the intervention. A second reason why random assignment studies are not perfect is, those who did the experiment may report the results incorrectly because of a mistake, subconscious biases, or monetary motivations that lead to bending the truth.
Now, I am not faulting researchers for trying to get some relevant evidence using the nonrandom assignment to groups methodology. Although random assignment to groups is considered the gold standard, carrying out long-term studies with psychiatric patients is almost impossible. Patients who are assigned to take the drugs often don’t take them, or don’t take them as prescribed, and the longer the study, the more likely this will happen. A significant number of patients wander off and can’t be found at various follow-up points. Many doctors refuse to participate in long-term studies that utilize a placebo group believing it is unethical to withhold a promising treatment for such a long period of time when they see their patients suffering; and over the decades newer, more promising interventions come along, so to continue to use the drugs that were popular at the start of the study would be considered unethical.
The most important finding from the set of nonrandom to groups studies my critic provided, from my perspective, came out of a 2009 study. There we find that patients that were on “antipsychotics” for less than 6 months had a lower rate of dying than those who were on the drug for longer periods. The authors note this in the results section of their article with a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.” This is accompanied by a graph showing this. Then, in the discussion section, the authors again mention this in a single sentence.
If you read just the abstract of the article, as many practitioners do because time reading research studies is not billable, you would find no mention of this statistically significant finding, a finding that could have life saving implications. And this finding can easily get lost in the numerous paragraphs of the study which focused instead on the evidence that those on the drugs for longer periods had a lower mortality than those who were said to be in the “no antipsychotic group.” However, the vast majority of the patients said to be in the “no antipsychotic group,” and probably all of them, actually were on these drugs at various points throughout the study. While they were hospitalized, they were almost certainly on the drugs, according to one team of researchers who had engaged in a similar study using the same data set, and many were hospitalized multiple times. What the researchers actually meant by labelling the group the “no antipsychotic group” were patients who didn’t take them each time they were released from the hospital. Thus, each time they left the hospital, they were suffering from withdrawal reactions.
There are a number of other serious problems with the design of these types of studies that was chronicled in a peer reviewed article that came out shortly after the 2009 study, including incomplete reporting of data, questionable selection of drug groups and comparisons, important unmeasured risk factors, inadequate control for potentially confounding variables, exclusion of deaths occurring during hospitalization leading to exclusion of 64% of deaths on current “antipsychotics” from the analysis, and survivorship bias due to strong and systematic differences in illness duration across the treatment groups. The writers of this critique concluded:
Thus, it is very possible that although a relatively higher percentage of patients not taking “antipsychotics” during periods when they were not in the hospital died when compared to the other patients during the five to eleven year periods that were looked at during the course of these studies, we still don’t know what would have happened if we could have looked at what age all of these patients ended up dying. The added risk factors that come with ingesting these drugs, such as weight gain and metabolic syndrome, may not exert their influence on mortality rates until a longer period of time.
This presents the theory that when compared to those patients in the other comparison groups, the group of individuals who did not take “antipsychotics” when they were not hospitalized may have had a higher percentage of members who not only avoid “antipsychotic” treatment, they also avoid all medical treatment. With this theory, it is not taking the “antipsychotics” that protects the patients from dying, but rather it is the increased likelihood that more “antipsychotic” compliant patients are more likely to comply with all medical treatment. Said another way, with this theory, we have less of a reason to conclude “antipsychotics” provide some protection from dying from these conditions; rather, it is this non-compliance to all medical treatment characteristic of some in the “no antipsychotic” treatment group that is the real cause for the statistical increased rate of death for those in this group during the relatively short window of time that these researchers were able to peek into.
In considering how dependable the evidence is from this entire set of studies, it is worthwhile to look how frequent they came up with contradictory findings. A few of the studies, for example, found a statistically significant decreased risk of suicide for those taking “antipsychotics” when compared to the so called “no antipsychotic” group, while another study that looked at the same data set found no significant difference. One study found a significant reduction in risk of dying when the patients used the “antipsychotic” clozapine, whereas another study did not find this, and found instead that clozapine was one of the drugs that appeared to slightly increase the risk of dying. A couple of studies found that even patients who took the highest doses of “antipsychotics” had a similar risk of dying when compared to a moderate dose, while another found the highest dosed patients were at an increased risk of dying. Thus, anyone making firm conclusions based on these types of studies is trying to build a house on shifting sands.
The first study that appears on his list was published in The Lancet in 2018, and titled “
These two studies were carried out by the same team of authors and applied a similar methodology using a data base from Finland. The first of these is titled, “Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of Patients in Community Care After First Hospitalisation Due to Schizophrenia and Schizoaffective Disorder: Observational Follow-up Study,” and was published in 2006 in the British Medical Journal. It looked at a nationwide cohort of 2230 consecutive adults hospitalized for the first time because of schizophrenia or schizoaffective disorder, from January 1995 to December 2001. All of the patients had been hospitalized at various points in time, and during their hospitalization, no record was kept to see if while they were there they had been placed on antipsychotics and/or other drugs. Those patients who chose not to fill their prescriptions whenever they left the hospital were said to be in the no antipsychotic group. However, it is very possible that many of the patients in this group had repeatedly gone into a hospital for various periods of time and while there were placed on an “antipsychotic,” or a cocktail of “antipsychotics” and other drugs, and each time they were discharged they went through drug induced withdrawal reactions.
Moving on to the other Finland study by this team of authors, it was published in 2009 in Lancet and titled “11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).” As I mentioned, it is very similar to the previous Finland study, but extends the follow-up period an extra few years. Both studies have very similar results. Those who are labeled as not using any “antipsychotics” but probably did use them when they were in the hospital, had relatively higher rates of death than most of the other comparison groups. However, the patients that had the lowest rate of deaths were those in the group labeled as using “antipsychotics” for less than 6 months. In the main body of the journal article the authors note this in a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.” There is a graph that illustrates this. It does repeat this again in another single sentence in the “Discussion” section of the report. Nothing else in the write-up of the report bothers to discuss this, and it can easily get lost in the numerous paragraphs defending the evidence that those on the drugs for longer periods had a lower mortality than those who were in the “no antipsychotic group” even though all of those patients in that group had probably been on such drugs each time they were hospitalized, and were only not taking them each time they were released from the hospital.
The next study on my critic’s list is titled “Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study” and was published in a 2016 edition of the American Journal of Psychiatry. The lead author is, once again, Dr. Jari Tiihonen, the same researcher of the last two studies that we looked at and who has numerous pharmaceutical industry conflicts of interest.
Using a very similar methodology as the Finland studies, it found that over a period of 5 years the prescription of moderate or high-dose “antipsychotics” for people labeled in Sweden as having schizophrenia was associated with lower overall mortality, compared to those said to be in a “no antipsychotic” group.” For those prescribed a benzodiazepine along with an “antipsychotic,” the results were quite different in that this group had the highest likelihood of dying when compared to the other groups. Thirty-eight percent of the patients were prescribed a benzodiazepine. Common benzodiazepines are Valium (diazepam) and Xanax (alprazolam).
This 2013 study, titled “Comorbidities and Mortality in Persons With Schizophrenia: A Swedish National Cohort Study,” was published in the American Journal of Psychiatry. It is pretty much the same type of study as the one’s carried out with Dr. Tiihonen and uses the same Swedish group of patients over a very similar time period as one of his studies, but here a different team of researchers looked at that data set. Again, lack of antipsychotic treatment was associated with elevated mortality. However, as hard as I looked in the article to see how the researchers defined “lack of antipsychotic treatment” I was not able to find it. As in other similar studies, most of those in the “lack of antipsychotic treatment group” were still alive, so we don’t know if they would, as a group, have begun to die at an earlier age if all were followed up until all in their group died.
This 2017 study, titled “Reduced All-Caused Mortality With Antipsychotics and Antidepressants Compared to Increased All-Cause Mortality with Benzodiazepines in Patients With Schizophrenia observed in Naturalistic Treatment Settings,” was published in Evidence-Based Mental Health. This study examined the same Sweden data set as our “Fourth Study,” but utilized a different set of researchers. The outcomes were largely the same. Five years were looked at. Compared to the “no antipsychotic” group, the prescription of “antipsychotics” for people labeled in Sweden as having schizophrenia was associated with lower overall mortality, unless they were also prescribed a benzodiazepine, in which case they had the highest likelihood of dying. As in the earlier Sweden study that I discussed, inferences from this study’s findings are limited due to lack of randomization to the various comparison groups which prevent differentiation of causal from non-causal associations. This study actually does not really compare patients who took no “antipsychotics” with those who did, because all of the patients took “antipsychotics” at various points in their lives. Despite statistical adjustment for some relevant baseline variables, highly relevant variables were unaccounted for, including direct measures of schizophrenia severity, unhealthy lifestyle behaviors, degree of substance use, medical comorbitities and treatment, health service use pattern, and treatment adherence. And, of course, the study just looked at what could be observed in a five year period at which point the vast majority of the patients studied were still alive. Such studies don’t reveal what the average age of death is for those who are labeled as having schizophrenia and are taking “antipsychotics” versus those who were also labeled as having schizophrenia but did not take “antipsychotics.” Like other studies that were done after the 2009 study, this one did not bother to find out if patients that were on “antipsychotics” for less than six months was the group least likely to die during the followup period.
This 2017 study, titled “Mortality and Antipsychotic Drug Use in Elderly Patients With Parkinson’s Disease in Nursing Homes,” was published in the Journal of the American Medical Directors Association. It looked at some data over a period of 18 months and does not directly address the issue under discussion. That is, these patients were elderly and had Parkinson’s Disease, rather than being labeled as having schizophrenia. For this group, prescribed antipsychotics for an 18 month period was not associated with the risk of death.
This 2015 study, titled “Antipsychotic Treatment and Mortality in Schizophrenia,” was published in Schizophrenia Bulletin. It looked at the same Sweden data set as our “Fourth Study” and “Eighth Study.” Each had looked at the follow-up that began on January 1, 2006 and ended on December 31, 2010.
Consequently, some of my readers showered me with praise for having the courage to stand up to the powerful pharmaceutical-psychiatric institutions, while others showered me with the most disrespectful insults known to the human race. 
And then there were those who disagreed with me but did so in a respectful manner. I believe it is my responsibility to now provide them a respectful response.
Any pill prescribed by a doctor will lead many to experience a placebo effect, which can be, for a period of time, helpful. I hasten to point out that a person can get a placebo effect with non-drug treatment approaches as well, and this would avoid the various harms associated with this type of drug.
These drugs are not only known as “antipsychotics,” but also “major tranquilizers,” because they sometimes do appear to calm someone in distress.
Unfortunately, once someone begins to take these drugs to help with agitation, when they try to come off of the drug, they are left with drug withdrawal experiences that have been described as awful. I hasten to point out that there are other ways to help someone to calm down that need not rely on these types of drugs. I have worked on many occasions with people who are agitated, and without the aid of a drug prescription I listened in a caring way, and in time the person eventually calmed down. If, however, you give someone a drug that calms the person down, it is sometimes much easier, and less time consuming. For people who witness someone they care about in high distress drift into a calmer state upon taking an “antipsychotic,” this can seem enormously helpful.
Some of them would have recovered in a fairly short period without the drug, but because they recovered while taking the drug, they, and their loved ones, attribute the improvement to the effectiveness of the drug. If the person tries to see whether the improvement was due to the drug or the natural recovery process, he or she may try to stop ingesting the drug.
However, the withdrawal from the drug, as I mentioned above, often causes a nasty physiological reaction which, in some ways, is similar to someone who is a coffee drinker who suddenly decides to stop, cold turkey. However, the “antipsychotic” physiological withdrawal reaction can be experienced as much worse. When people who care about this person see the downward spiral that occurs from the physiological withdrawal reactions, they may come to attribute it to the person’s “mental illness” returning, and thus, the illusion of long term effectiveness is now deeply entrenched.
Another way in which the illusion of the long term effectiveness of the drugs can occur has to do with the fact that even when the “diagnosed” person is not functioning well on a drug treatment regimen, human beings can always imagine that the patient would be doing even worse without taking the drug. And of course, when the patient does try to go off the drug, the raging physiological withdrawal process occurs. So, in this way, the combination of the belief that the patient could be doing worse, and upon becoming worse when trying to do without the drug, it convinces people that the drug treatment is helpful.
Once they take that position, and tell others what they had done, information that comes their way in the form of the distressed person having bad side-effects, or hearing from people who take the position that the drugs may be more harmful than helpful, a psychological phenomenon known as cognitive dissonance occurs. The principle of cognitive dissonance states that human beings strive for internal psychological consistency. When they experience internal inconsistency they become psychologically uncomfortable and a major way that they try to reduce the discomfort is by avoiding circumstances and contradictory information likely to increase the magnitude of the cognitive dissonance.
I have publicly supported the argument that these drugs cause more harm than good. Therefore it can be argued, it is I who suffer from cognitive dissonance whenever evidence comes my way that might support the idea that these drugs are helpful in the long run.
By the late 1990s, investigators had reported that antipsychotics caused basal ganglion structures and the thalamus to swell, and the frontal lobes to shrink, with these changes in brain volumes “dose related.” Then, in 1998, Raquel Gur, from the University of Pennsylvania, reported that the swelling of the basal ganglia and thalamus was “associated with greater severity of symptoms.”
The MRI studies provide objective evidence that antipsychotics cause changes in brain volumes that are associated with a worsening of symptoms, and a worsening of functional impairment.
And so, parents start getting phone calls from these frustrated teachers, urging them to consider having their son or daughter evaluated for ADHD. “There are medications available for children that help these kinds of problems,” the teachers explain.
To do my best to offer balance to the pharmaceutical industry’s point of view, in earlier posts I review the research pertaining to how effective and ineffective these drugs are (see 
That is, many of these children have no problem paying attention to many types of tasks, such as art projects, singing songs, and playing sports, but find academic school lessons boring. 
Others are the youngest student in the class and are actually acting in a manner typical for their age.
Nevertheless, it does sadden me when I hear about this decision, for I become concerned about the child’s stomach, kidney, nerves, hormones, developing brain, and bone structure. Drugs that physicians have said are safe and effective have, in the past, proven to be far more toxic than anyone ever dreamed. The latest such case involves the use of pain killers that fall in the class of Oxycontin, which many physicians cooperated in creating a situation now declared a national emergency. I for one have been deeply grieving over the suffering of the tens of thousands of family members caught up in this horrible deadly mess.
I grieve as well over the social misery that goes along with being singled out as a child that must take a pill to fix the problem said to be in his or her brain. More than a few kids have told me that this process, for them, became a dreaded experience.
I prefer to put forth a view that encourages us to teach our kids about the value of keeping our bodies in lifelong possession of its full youthful state by avoiding the use of stimulants and narcotics. I wish to teach our kids it is possible that the morning sun and air are far better and healthier intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being–these are the directions I wish we would point to when we guide a child toward a fulfilling life.
In the article, Dr. Szasz put forth his belief that the behaviors and experiences that are considered “mental illnesses” are more accurately construed as problems in living. As someone whose family narrowly escaped the violent, inhumane actions of Hitler in 1938, he expressed a concern about society giving psychiatrists the authority to convert these problems into a language of illness. As he saw it, his own profession has a financial interest in converting more and more problems in living into illnesses that require its services to reach some vague harmonious state thought of as mental health. However, according to Szasz,
To Dr. Szasz, it is logically absurd to expect that it will help solve these types of problems by prescribing tranquilizers and other drugs as if they were like a bacterial infection, or the growth of a tumor. To be sure, people on their own have tried to deal with these problems by taking a wide range of drugs, such as alcohol, tobacco products, stimulants, and heroin. Such approaches, rather than promoting healthy outcomes, tend to lead to less healthy outcomes. 
To Szasz, changing to the drugs doctors prescribe to deal with these problems in living is like changing seats on the Titanic.
Dr. Szasz’s book, Law, Liberty, and Psychiatry, also was met with high praise. In a review published in the New York Times, Edward de Grazia wrote;
One boy had recently become depressed. When I asked him why he thought he was depressed, he said that his mother was making him take Ritalin to treat his ADHD. The boy didn’t believe he had ADHD, and when the drug’s stimulant effects began to wear off each evening, he was left feeling awful, with waves of sadness, stomach aches, and difficulty falling asleep.
At the same time, I had become concerned that so many of the kids referred to me who were in foster care were on drugs typically prescribed for people diagnosed as psychotic. These students typically were dealing with serious emotional challenges involving being taken from their parents’ home. A couple of these cases involved parental child abuse, others involved parents being sent to prison, and I had another case of a boy dealing with his parents dying in a car accident. My efforts to help these grieving kids became ever more difficult because of the side effects of the psychiatric drugs prescribed to them. Some of the side effects were known to be life threatening.
Regarding the October 3rd Binghamton Conference, I am writing in great dismay and utter incredulity that so much mental health money would be spent in this fashion. The money for the needed basic services has been so sharply reduced for our ill family members; plus with the number of mentally ill homeless ever increasing, then to see the large number of participants in such a program was definitely upsetting to me.
This time I did add to the panel a family member who belonged to the local chapter of the National Alliance On Mental Illness. Despite that, I received a letter from the president of that organization’s New York State chapter asking that the debate be cancelled. In his letter, he specifically objects to Dr. Szasz expressing his views.
Over the years, I found his love for his two daughters particularly heartwarming. I could easily relate to his feelings toward them because I have two dear sons.
So, what do you do in a situation like this, that is, a situation in which some people highly respect your friend, while others don’t? As for me, when I meet someone saying negative things about Dr. Szasz, I take some time to listen carefully, and I respectfully summarize the person’s position. I then gently say a few supportive things about Dr. Szasz, while bracing myself to deal with the person’s reaction. As the other person replies, I again listen, seeking to be as empathic as possible.
Mentoring programs, which provide one-on-one relationships, such as the Big Brother/Big Sister Program have demonstrated they can be helpful, but most communities find they have a severe shortage of mentor volunteers. 
In addition, it has become apparent that some who do manage to get mentors need significantly more time with a positive role model then the hour or two per week that mentoring programs typically provide.
It would begin with offering an elective course to high school and college students titled “An Introduction to Counseling and Conflict Resolution.” It would provide lessons on basic counseling skills such as empathic reflective listening. A major unit in the course would be on how to discipline children nonviolently, and another unit would be on how to teach skills for dealing with anger arousing situations.
These interns would serve as mentors for younger students at least four years younger than they. For their participation, mentors would receive an authentic sense of helping their community, a modest stipend of about $4 an hour, earn additional course credit, and have an opportunity to receive a sterling recommendation for any future job or advance education opportunity. Survey data that was administered at my school district and local college indicated there would be plenty of students who would agree to become mentors if the program became funded.
On site at each high school would be two adult supervisors, one of which would be a psychologist, the other, a volunteer senior citizen.
Then they would work for twenty minutes doing homework.
Every 6 weeks, all of the parents of the mentees would be invited to an evening meeting. The focus of these meetings would be on seeing the little video shows that their sons and daughters had made that illustrate peacefully handling some conflict.
Our tale begins when Tony is 12-years old. Because of several fights that he has gotten into at the afterschool program, Tony has just been banned.
Shortly afterwards, Nick, 17-years old, begins to mentor Tony every day after school. Nick had been bored before beginning to work with Tony, and without this constructive activity available, he could have easily gotten into trouble. But now he finds that the way Tony looks up to him very rewarding, and Nick gets great satisfaction knowing he’s helping his community. And he also likes the money that he’s earning from the stipend.
June, 11-years old, is wearing a cute pink dress. She has been brought to see Dr. Shure, a psychologist. Leaning forward on her desk, Dr Shure asks,“Do you know why your mother asked me to meet with you, June?”
“Really!” exclaims June. “She’d be like a big sister! I’d love to try something like that!” A delightful smile is now lighting up June’s face.
In this One-On-One Program, the mentors would benefit because it would give them something constructive to do instead of getting embroiled with some harmful groups of bored students looking for trouble. 
They would learn useful skills taught in the counseling and conflict course and be given an opportunity to apply peace promoting skills in real life situations under supervision, skills that they would be able to use later in life and to a time when they become parents. They would also earn some money, and work daily on developing some valued skill.
For thirty mentor-mentee pairs, the cost would be approximately the same as it would be to send one young person to a juvenile correctional facility or prison for one year. 
So, if the One-On-One Program was to succeed as a violent prevention program, with fewer folks going to residential programs or prisons, and fewer folks being rushed to the emergency room to be treated for a violent injury or attempted suicide, communities would actually end up saving hundreds of thousands of dollars. Of course it is my hope community members will think beyond the money that can be saved, and act to make the One-On-One Program a reality because this is in the best interest of our youth, and our entire community.
This labeling process relies on descriptions provided in the Diagnostic and Statistical Manual of Mental Disorders–Fifth edition (DSM) and the International Classification of Diseases–Tenth edition (ICD). Both are manuals that are conceptually similar, utilizing as their core concept, mental disorders, and both share the same “diagnostic” codes. Because of their similarities, I will simply refer to them as the DSM/ICD approach.
Many professionals defending the use of this approach explain that it provides a common language for mental health professionals to communicate about those utilizing their services; its various classification terms, such as major depressive disorder, anxiety disorder, and so on, are short phrases that are convenient for placing into titles and search engines, and for efficient/streamlined communication in high-speed hospitals and clinics; third-party payers of mental health services have found that their coding system works well as part of a practical method for their record keeping; with the aid of these codes, people manage to access mental health services, mental health service providers manage to get paid, and for-profit health companies tend to make a profit.
It tends to be stigmatizing to mental health service users. The lack of reliability and validity of the various so called diagnoses violate basic principles of science. The process of coming up with a psychiatric label privileges the clinician’s perspective over that of the mental health service user. It ignores the fact that many people who have been labeled with these stigmatizing psychiatric terms come to realize that the experiences which led to their seeking services, rather than being an indication of a pathological condition, are really an essential element to their creative development. Many have also expressed concerns about the “mental illness” terminology which medicalizes mental health concerns, thus leading to an incredible number of people being prescribed psychiatric drugs, the use of which leads to numerous serious side effects.
Just as I was writing this post, major news outlets began to report that researchers found nearly a 50% increased odds of dementia for those taking the most popular drugs for treating depression and other mental health concerns. Although the study could not prove conclusively that these drugs caused the increased risk of developing dementia, because these same drugs had already been linked to confusion or memory issues, the new evidence is deeply troubling. The researchers expressed concerns that if this association is causal, it “would equate, for example, to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom.” With the population of the US being 6 times larger, this could mean that over 100,000 cases of dementia may be attributed to these drugs every year here in my own country.
As part of this effort, I have come up with one alternative proposal which I discuss most extensively in a peer reviewed article published in a 2018 volume of the Journal of Humanistic Psychology (see 
The CSM approach begins with a full recognition that individuality outruns any classification system. It is for this reason that the CSM does not classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider. A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, meaning of life, death, dying, managing chronic pain, addiction, work, relationships, education, eating, cognition, sleep, and challenging life situations.
Classifying the expressed concern would provide mental health service providers a common language that is helpful when communicating among other professionals. So, a professional might say to a colleague something like, “My 9:00 a.m. case is concerned about feeling depressed, my 10:00 case is concerned about his failing grades, my 11:00 case is concerned about how anxious she is in social situations.” Such communications are straightforward and easy to understand, not only for professionals, but for the general public as well.
Each expressed concern listed in the CSM would be a sufficiently short phrase so that it can be conveniently used in titles and search engines to retrieve valued relevant information. Along with each classified expressed concern, there would be a numerical code that would be convenient for third-party payer bureaucratic record keeping.
This process involves a mental health service user and a mental health service provider co-constructing a hypothesis or “best guess” about the origins of the mental health service user’s concerns in the context of his or her relationships, social circumstances, cultural heritage, life events, and the sense that he or she has made of them. Once it has been established what the concerns are, the immediate next question is, “How do we jointly understand these experiences, why they arose, and how we might be able to address them?” This formulation is not something that is shared with third party payers of mental health services, but is utilized exclusively by the mental health service user and service provider.
With the CSM approach, no one is viewed as mentally ill, having a mental disorder, or having some psychopathological condition. Instead, it highlights that the progress of society is due to the fact that individuals naturally vary from the human average in all sorts of directions, that the originality is often useful, while, at the same time, being different can create a variety of concerns. Moreover, some people become concerned about how they are handling enormously stressful and traumatic experiences. Still others are living in unhealthy ways, such as making unhealthy choices in what they consume, or getting insufficient exercise. Mental health professionals, with the CSM approach, are viewed as seeking to address these types of concerns that arise from these conditions in a supportive setting while relying on a variety of wisdom traditions. Central to this approach, is an honoring of what Ralph Waldo Emerson referred to as the grand sweep of humanity.
Compared with the DSM/ICD approach, the use of the CSM would be less stigmatizing, more respectful to those seeking services, and more practical because of the ease of understanding the words and phrases that it utilizes. Moreover, it would be more consistent with principles of science because instead of using as its core concept the vaguely defined “mental disorders,” the CSM uses as its core concept “mental health concerns,” which is a clearly recognized event that occurs at a specific time and place. Finally, the CSM approach would provide a new choice to both mental health service users and providers, challenge old ideas, stimulate fresh perspectives, and open new avenues of research.
In an article titled, “What Might an Alternative to the DSM Suitable for Psychotherapists Look Like?” Jonathan D. Raskin notes that recent surveys of psychologists and counselors indicate they are dissatisfied with the DSM/ICD approach and are interested in coming up with alternatives better suited to their professions. Nevertheless, more that 90% said they will use the DSM/ICD; after all, that is how they get paid by third party payers.
In a commentary on Dr. Raskin’s article that appears in the same JHP issue, Rachel Cooper, a senior lecturer in philosophy at the United Kingdom’s University of Lancaster, and author of Diagnosing the Diagnostic and Statistical Manual of Mental Disorders, puts in some of her own thoughts on this topic.
She begins by agreeing with Dr. Raskin that most psychologists and counselors would be keen for an alternative classification to be developed. She then reviewed research indicating that social workers should be included among the professionals unhappy with having to use the DSM/ICD approach. In surveys, most indicated they would not use it if it was not required for insurance purposes.
She then refers to my CSM approach, stating that I suggest that insurance companies could be persuaded to pay for “Mental Health Concerns,” as they would readily come to understand, with a little explaining, that mental health service providers now using the current DSM/ICD approach do not turn anyone away who has mental health insurance coverage and comes to their office expressing what the CSM refers to as a mental health concern. She then writes,
First of all, when Dr. Cooper says insurance companies usually try to prevent mental health providers from recording diagnoses to facilitate payment even in cases where a diagnosis criteria is not met, I strongly disagree with her. I’ve never in my entire career heard of an insurance company questioning a diagnosis, and on what basis could they possibly do so? Insurance funders are not present in the room when a so called diagnosis is made. All that they get as documentation for a given diagnosis is a code indicating the diagnosis.
In an extraordinary Feeling Deeply podcast, Emily Whyte Rubin, my daughter-in-law, interviews Jack Baxter, a guy from London who, having struggled with these issues, started a program to help others who are dealing with similar challenges. Called, “Good Grief,” the program essentially assists people to come together in small groups to share their experiences and to support one another. Let’s take a few minutes to look at some of that interview, and then I’ll express my views on this topic, and then invite those of you who are reading this post to weigh in.
“Sure. I’ll tell you a little bit about my story. It started with sadness, unfortunately. It started when I lost my father, Dave. He was 48. He was my best friend. You know, people talk about soulmates; I don’t believe you only have one soulmate, because, you know, I met someone else that I can label that. I’ve since met another soulmate, and I hope to continue to meet more, but my dad was very much my first soulmate; he connected with me in ways that I never connected with anyone. He was my best friend. I could tell him anything, and likewise, he would tell me anything–his advice, his wisdom, and I was lucky enough to have that man for twenty-two years. 
“Sadly, he passed September 13th. He had skin cancer, which was, you know, tough for anyone to deal with, as you can imagine. I was only twenty-two at the time. It was like the center of my world had fallen out. It was a very tough time for me to deal with. I no longer had that support, and of course I had some friends and family, but no one like my dad who was, you know, who was there for me at times when I needed him most, and to be honest, I need him even now. You know, a young man needs his dad. And, well, we went on a journey of self discovery and I believe he was with me all that way as well. I made mistakes, ups and down, left and right, and, but, you know, I eventually sought some direction in “Good Grief” which, um, is a support group that I launched with some friends, Ben and James, and we offer support and advice for young people, in London at the moment, but we hope to venture out wider then that, for young people who have lost love ones, much like myself, and Ben, whose father died recently of brain cancer…. 
For me, personally, I tend to grieve internally, letting the experience flow through me, and I don’t feel a need to reach for a supplemental support group. In the past, when someone close to me died, I went to the funeral, spent a few days with people close to me, and then I processed the most challenging aspects of the experience that was, and is still, running through me mostly on my own. I have a supportive wife, and my children are a great source of comfort to me.
Although my personal approach is working for me, over the years I have met people who, it seems to me, really would benefit with the type of group Jack has put together. For example, a friend of mine whose wife died suddenly is now in his house all alone. It has been very rough on him. What a wonderful resource it would be for him if he could share what he has been going through, and offer support to others in a Good Grief type group. And I know others who, within their family structure, would meet with disrespect when showing any signs of tearfulness. “Man-up!” would be the demand they would face, or, “Don’t cry, it will all be okay.” For these folks, a more supportive group could be an enormous help.
It’s a Sunday night. Eight-year-old Carl is playing a computer game. Suddenly, his mom cries out, “Time to head up to bed, tomorrow’s school.”
“Don’t ‘but mom’ me, let’s go,” and she takes Carl firmly by his arm and begins to guide him to his bedroom. Carl’s eyes tear up, which infuriates his mother, and she cries out, don’t you start with this crap or I’ll give you a real reason to cry! You’re acting like an infant!!! Now you stop this instant and get to bed!!!”
“I see you are feeling sad. That’s understandable. You were enjoying the game so much, and you’re disappointed about having to stop. You know, when we feel sad, it’s to help us figure out how to better handle what we do in the future. I wonder how we can better handle the going to bed situation in the future. Any ideas, Carl?”
We could also go to the library and pick out some books that have pleasant short stories, and you can read one right before bed. Short stories come to an end in a reasonable period of time, and the reader feels a sense of completion when it’s over, without making you feel like you have to read the next chapter to see what happens next. That might work also. So, in the future, why don’t we try having you each night choose one of these ideas. I’ll let you decide each night which approach feels right to you.”
Suppose a guy named Fred tends to be sad more than the average person. This might be due to some natural born tendency to experience life in a more sensitive manner than most, or because of some rough stuff going on in his life, or some trauma in the past has been leading to recurring anguishing memories. For whatever reason, Fred regularly comes to work expressing his sadness from the look on his face as he goes around doing his job. Co-workers often stop what they are doing to ask what is wrong, and offer help by taking time to listen to Fred in a caring way. This would be nice in some ways, but let’s say it happens so often, coworkers begin to find that their work at the end of the day doesn’t always get done on time and they end up having to stay late. 
Some resentment begins to arise. Moreover, in this scenario, the boss begins to dislike what has been going on partly because of the time being taken from the tasks that have to get done with top-notch efficiency in a competitive business environment, and she was brought up by parents who taught that there is something wrong with people who are sad more than average. In the end, Fred loses his job.
Perhaps Fred, if he could afford it, would be better off hiring a professionally trained personal counselor to help him work through his sad experiences in a positive manner so that he doesn’t put too much on the shoulders of friends and family members. There are, in most communities, some counselors available, and at the top of any of my blog post there is a link titled “Counseling Services” that when clicked on provides descriptions and contact information for two excellent personal counselors that I personally can recommend who conveniently provide services through Skype, Zoom, or your phone.
However, counseling services do cost money, and if it is too expensive for someone’s budget, an alternative is to set up via such internet resources like meetup.com, a support group that meets regularly for the specific purpose of sharing challenging emotional experiences. Of course, the members will be unlikely to have the expertise of a trained personal counselor, but with trial and error it is often very possible to find the right mix of caring, empathic participants.
We’re here to emotionally support one another.
The Provigil made it hard for Laura to sleep, so her pharmacologist prescribed Ambien, which she took every night. In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.
It was at this point that Laura decided to see what would happen if she stopped taking the drugs, and found that the process was an excruciating experience because of the medication withdrawal reactions. It took her many extremely rough months before her goal was achieved.
Prior to coming off the psychiatric drugs, Laura had been unable to have stable relationships. “I honestly thought that, because I was mentally ill, the numbness was just part of me.” Now she wondered about the other effects of the many medications she had been taking. “On this very sensory, somatic level, I couldn’t bond with another human being,” she said. “It never felt real. It felt synthetic.”
From today’s post, I hope that you will consider the value of giving up any belief that you may have that feeling sad means you are bad. If, when you experience sadness, you find yourself saying such words like, “I can’t believe I’m feeling sad again, what an idiot I am,” consider how it may be far more helpful to view your sadness as a useful tool for helping us to better plan our future. If you are a parent, consider the value of teaching your children this “sadness is a helpful tool” idea.
For some, like Lincoln and Joni, their suffering never completely went away, but they, in a sense, made friends with it. They did so by coming to understand that experiencing challenges more deeply than people with a happy-go-lucky temperament has the potential to provide a motivating force to bring forth valued achievements. As Joni so beautifully expressed this, 
Leo Tolstoy provided us the most vivid example. His depression stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common people, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. By spending more time in nature and in a supportive community, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.
William James’s story is more in line with this second type of depression experience, in that he, like Tolstoy, found that by making certain changes in how he was living and the situation in which he was living, his experiences of dealing with depression decreased to a point that he felt he was getting more out of life. I briefly reviewed these changes in an earlier post titled, “William James’s Personal Bout with a “’Mental Disorder’” (see 
Simultaneously there arose in my mind the image of an epileptic patient whom I had seen in the asylum, a black-haired youth with greenish skin, entirely idiotic, who used to sit all day on the benches, or rather shelves, against the wall, with his knees drawn up against his chin, and the coarse gray undershirt, which was his only garment, drawn over them, inclosing his entire figure. He sat there like a sort of sculptured Egyptian cat or Peruvian mummy, moving nothing but his black eyes and looking absolutely non-human. This image and my fear entered into a species of combination with each other.
It is of special interest that William tells us that his experience “has made me sympathetic with the morbid feelings of others ever since.” For those of us who value people who can sympathize with those having such feelings, we see that something positive came out of William’s own experience. This theme that depression is often a tool to create something of value, runs throughout William’s writings for the rest of his life.
Initially, William, upon having his fearful experience believed that all mental health concerns now referred to as mental disorders are required to have a physical basis and that there was nothing anyone can willfully do about them. Today, short of taking a pill, many of today’s psychiatrists are promoting a similar view. Thus, their basic position is that these concerns are due to something within the patient’s physical makeup. This misses the overwhelming evidence that how people construe their past and current experiences, and their current social and work situations, are often the central causative factors.
One thing that he had decided to do was to spend more time than he had been on focussing on some uplifting life experiences. For example, he began to read poems by William Wordsworth. Consider Wordsworth’s poem, “I Wandered Lonely as a Cloud.”
Continuous as the stars that shine
For William, the delight that Wordsworth had for the beauty of nature was catching, and William began to spend more time in nature, especially in the Keene Valley area of the Adirondack Mountains. Also, of enormous help, was to find the right type of work for his temperament, as we see from a letter he wrote to his brother, the gifted novelist Henry James:
