Dr. Mark Foster on non-drug alternatives for mental health

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Well, I recently had the pleasure of meeting Dr. Mark Foster in person at a local mental health conference. He is, of course, the physician who was terminated by his employer in Colorado when his "awakening" after reading ANATOMY OF AN EPIDEMIC changed his perspective forever on psychiatric drug prescribing. He is currently in the early planning stages of starting a psychiatric medication withdrawal clinic in Colorado, the first of its kind. To get up to speed on him and his situation, go to Whitaker's blog here

 

Anyway, he kindly emailed me his speech and his founding principles for his clinic, which I have pasted here, the most cutting-edge of psych boards (I recommend printing them out for close reading. There's some real stand-up-and-cheer stuff here and it all just throbs with such a rare, courageous humanity). I can tell you that his speech was even more impressive in person, and was gratefully received by the audience. It was utterly surreal to hear a physician talking like this, but there it was. And he's humble and knows his limitations. Yes, you heard me right. Kudos to Mark. May he be the first in a long, proud line of physicians (and...gasp...PSYCHIATRISTS?) who take a more holistic, (TRULY) evidence-based approach to mental health.

 

So, without further ado, I present Mark's words...

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Towards Mental Wellness

by Dr. Mark Foster, DO

10 June 2011

 

 

My name is Mark Foster, and I am . . . who? Who am I? This is a loaded question. In fact, this is the fundamental question of life. Whoa. Heavy stuff for an intro. Here I am, speaking at this conference, an unknown soul to virtually all of you, and I’m asking, Who am I? The words I am about to use to define myself are going to carry great weight, and will affect your perception of me. The way I label myself right now will shape how you receive what I have to say. If I call myself an expert, you might think one thing of me, and if I call myself a radical, you might think another thing. (I consider myself neither, by the way.) But what if I called myself bipolar, or obsessive compulsive, or schizophrenic? What would you think of me then? What would I be indicating about how I think of myself and my potential? (Right now, you might be thinking that I'm simply neurotic--I'm supposed to just be introducing myself, after all.) But let's stick with this for a second. Labeling is such a powerful action, it profoundly, invariably affects our self-concept and how we are perceived and received by others and by society.

 

Let me illustrate this for you with a case study. Recently, I saw a 15 year old boy named Tommy in my family medicine clinic for a check-up. He is slightly built, with moppy hair and those super-skinny jeans that teens wear these days. He's witty and silly, gets good grades and is a talented artist. In fact, he recently placed second in a district-wide oil-painting contest. Physically, he's in great shape, although I told him he should really get some better jeans. He laughed at that. But when I asked about his behavior, things took a different turn. His mother was with him, and she answered for him, "Well, that's a big problem,” she said. “I have an appointment with a psychiatrist next week."

 

This surprised me. There was nothing about Tommy that would give the impression of mental illness. So I asked Tommy an open-ended question: "Tell me what's going on with your behavior." Tommy's face drooped, and he looked at me through his moppy hair and said uncertainly: "I dunno. I guess I'm bipolar." I asked him why he thought that, and his mother again replied for him, "Well, I'm bipolar,” she said, “and so I recognize all the signs. He's up one minute and down the next, and he's started having these explosive anger outbursts. I just want to get a handle on it. Trust me, you don't want to see me off of my meds."

 

We spoke for a while longer, and my heart broke for this bright kid. It seemed so obvious to me that right now Tommy needs support, acceptance and role-modeling, not psychiatric labeling or medications. It seems that he was having a label imprinted upon him by his mother, whom I know is well-intentioned, a single mom struggling to raise a teenage son by herself. But the label she was giving him--bipolar--was derived from her own experiences with psychiatry. She now was transferring that to her son, in effect handing him a script for life, and there could be little doubt that the psychiatrist next week would concur with mom and give him a diagnosis and drugs, perhaps a cocktail--for this is what psychiatrist‘s do. Thus, talented young Tommy was about to be convinced by authority figures that his behavior and mood swings were part of a pathological disturbance of his brain, dangerous symptoms of a disease that must be eradicated and can only be controlled by drugs. Tommy was being guided lovingly down a pathway of self-esteem destruction and iatrogenic disability.

 

I wanted to share these thoughts with Tommy and his mother, but I had a fine line to walk. I didn't want to devalue mom's opinion, or her own diagnosis, and thus run the risk of alienating her and losing Tommy as my patient, because I thought that I just may be the only counterbalance to the meds and labels that he would be given. I gently shared my opinion that medicines could be harmful, that we've got to consider all non-medical alternatives first. His mother was actually somewhat responsive to this idea, but indicated that she still wanted the psychiatrist's opinion.

 

With a sense of desperation, I was able to maintain eye contact with Tommy, and I told him, "Tommy, I want you to hear something from me. I'm just one doctor, and I have my own opinion about these things. Other doctors feel a lot differently than me. But I want you to know that I think you are an amazing young man with a bright future. I can see it just talking to you. I don't think you are broken, and I don't think you have a disease. I know you are struggling with some mood issues, but I think, if you pay attention, there is something very valuable about yourself that you can learn from your struggles. So much is going on in your life right now. Medicines might make you feel different in the short term, but long-term, you don't want to be numb to your feelings. You want to appreciate them and cope with them in healthy ways. It's going to be up to you. Just remember what I'm saying, okay?"

 

Maybe I'm kidding myself, but I'm hopeful I connected with Tommy in a way that he understood me. I think he was desperately seeking for it, actually, for some adult to tell him that it's alright to feel confused and angry, and that he's worth something valuable just the way he is. Maybe my words will lodge somewhere deep in his memory vault, and he will access them one day to help himself climb from the pit that our mental health system is about to cast him into.

 

I share this story to illustrate the power of labeling. With that grave introduction, what labels should I choose to present myself to you today? I would prefer to call myself simply a human being, an irreducible and exquisitely unique soul, just like all of you, a fellow traveler on this journey of life.

 

But perhaps you would like some more specific details. Well then, I am also a husband and a father, a physician and a writer, both an interested observer and an active participant in the battle raging for the soul of mental health. I drive an old beat up truck. I owe just about as much on my school loans as I do on my mortgage, and trust me, that's not a good thing. I attended medical school in Arizona and then completed my family practice residency in Colorado in 2006. From there, I went to practice what we call cowboy medicine in Worland, Wyoming, population 5,000. No, you probably haven't heard of it.

 

For two years, I was a do-it-all doctor, delivering babies, performing minor surgeries, working the emergency room, doing inpatient and outpatient medicine, pediatrics, and yes, lots of mental health. I sat on the county mental health board. This was not because of my expertise, per se. There was simply no one else to do it, no psychiatrist for 200 miles. After two years of rural fun, my wife and I wanted to get back to Colorado.

 

Back in Littleton, I worked hard to open a hospital-owned family practice clinic. My work was respected and the clinic was successful, that is until my opinions and writings about mental health reform-- what the hospital termed “my alternative practice style”--made me an outlier within the medical community. I became perceived as a loose cannon with whom the hospital did not wish to associate anymore, and so they terminated my contract. That was three months ago. I am currently working urgent care shifts, writing a book, and trying to figure out what comes next for me and my family. I will be joining an integrative medical practice in Colorado as a part-time physician within the next few months.

 

Additionally, I am working closely with a brilliant woman and former consumer, Amy Smith, who is here today. We are creating a non-profit in Colorado called Clear Minds, dedicated to education and advocacy for mental health reform. Our ultimate hope is that our regional advocacy can create the conditions and connections to bring a brick and mortar Psych Med Optimization Facility to Colorado, dedicated to helping people withdraw from psychiatric drugs and achieve mental and spiritual wellness. We will be discussing our ideas and looking for input in a workshop tomorrow.

 

So, these are some of the things that I am. Here are a few things that I am not. I am not a psychiatrist. I have never worn a bow-tie or a cashmere sweater. I have no Ivy League degree. I certainly have no lucrative ties to pharmaceutical companies. Witness my truck.

 

But although I am not a psychiatrist, being a family doctor still makes me relevant to the mental health crisis. Many people are surprised to learn that over 70% of mental health visits, and the majority of psych med prescriptions, are handled by primary care physicians, not psychiatrists, which places us at the very epicenter of the epidemic.

 

My enlightenment about the dismal realities of biopsychiatry began with two books, Anatomy of an Epidemic by Robert Whitaker, whom we will have the privilege of hearing from on Sunday, and Your Drug May Be Your Problem, by Dr. Peter Breggin, a true visionary who has been combating the excesses of the biopsychiatric model of care for decades. To explain the impact that these books had on me, I want to briefly digress.

 

Have you ever seen the movie the Truman Show with Jim Carrey? One of my all time favorites. In it, Truman is a man who was born, raised, married and lived his entire life on a gigantic, elaborate television set. From his earliest memories, he was utterly convinced that this stage was a real place, that his wife and friends were real, although they were simply actors. He had never known anything different. As the show's creator explains, "We accept the reality with which we are presented." Truman is restless but can't say why, until one day a stage light falls from the fake sky and shatters on his street. This bizarre occurrence is quickly explained away to the still-believing Truman by further artifice from the producers, but Truman now begins to sense that something is terribly awry in his world. His awakening results in a heroic struggle to discern the true nature of this false reality, and then to navigate his own escape. He does so triumphantly, disappearing into the uncertainty of a dark doorway marked exit.

 

For me, Whitaker and Breggin's books were like that stage light falling from the sky, like Morpheus offering me the red pill in the Matrix. The books set me on an intellectual journey to re-evaluate the paradigm of mental health that I had simply accepted as true.

 

This journey has revolutionized my practice in positive ways, but there have been serious repercussions, too, including being isolated from my medical colleagues and terminated from my employment. There is simply such overwhelming societal and academic belief in the efficacy and necessity of medication for mental distress. What has kept me pursuing this course is first, the truth, and just as important, my patients who have benefited in demonstrable ways.

 

For instance, I saw a very pleasant Bulgarian man named Nickolai recently. He is my age, with three children almost exactly the same ages as mine, so I felt an instant connection with him. He immigrated to the United States 15 years ago, and he owns his own picture framing business. He is thin, with long swept back hair, a goatee and wire-rim glasses. He has a thick accent, and is self-conscious of his English, though he actually speaks quite well.

 

He first came to see me a few months ago. At that visit, his chief complaint was a racing heart and insomnia. We did an initial medical evaluation that suggested no primary organic problems. I asked him why he couldn't sleep, and he said that he has been very anxious recently. He lays in bed all night worrying about his life, and this is when his heart starts racing. It turns out that his business is struggling in the poor economy, and there has been a lot of fall-out from that, especially in regards to his marriage. He feels the stresses of a provider who is not certain how he is going to feed his children next week, which must be a heavy burden indeed.

 

When he came to see me, it was at the bequest of his wife. He was nervous and reserved. As I took his history, I asked him what the problem was, and he said with resignation in his thick accent, "I don't know, I think I probably need a pill to help me out." As I was a doctor, his only expectation of me was that I would give him a pill. When I divulged my concerns about turning to pills as a first resort, he seemed suspicious, but as our conversation continued, he noticeably brightened. I told him that I did not believe that the symptoms he had described were part of an organic disease, but rather a very understandable human response to the difficult circumstances he was facing. I reassured him that with time, this could be expected to get better on its own, and then I provided him a handout that detailed specific strategies to improve mood and mental wellness, such as exercise, healthy diet, meditation, nurturing friendships, etc.

 

When I saw him back for follow up a few weeks later, he was smiling. There was energy in his step, and he could hardly refrain from expressing his gratitude. He shook my hands several times as he told me that he had been exercising everyday, sleeping better, and hadn't had a single episode of racing heartbeat. I congratulated him on his efforts and the obviously good results. He said, "Doctor, I am so glad you didn't put me on pill. I didn't want to take it. And now I feel so much better. I am telling all my friends about you. Dr. Foster is now famous in Bulgaria!"

 

Of course, his recovery had almost nothing to do with me. I simply refrained from offering a seductive short-term fix, and provided some general counsel designed to help him take accountability for his mental wellness. The biggest thing was the perspective shift, and it took surprisingly little persuasion from me for the message to find its resonance. In his case, with his temperament, I feel very good about his potential for long-term wellness.

 

If only all of my encounters turned out so well. Now, I’m smart enough to share with you today only my success stories. But sadly, there have been many patients who are too addicted to their diagnostic labels and medications, too ensnared in the tentacles of biopsychiatry, to be able to muster even the desire to try a different approach. But I’ve been planting seeds, and I’ve been pleasantly surprised that most of my patients have been open, often enthusiastically so, to a more holistic approach, one that legitimizes the humanity revealed within their mental suffering, and offers hope for a non-medical approach to wellness, something that encompasses the mind, soul, and spirit, not just the brain.

 

One thing that has struck me as I have peeled back the layers of this onion is how cynical and pessimistic biopsychiatry’s leaders have been every step of the way. If you haven’t read it yet, then you must read another of Robert Whitaker’s books, Mad in America. (Honestly, I’m not shilling Bob’s books today, but I can’t really overstate the dramatic effects his research and writing has had on me.) Mad in America is superbly written--and deeply disturbing. In it, Whitaker details the whole sordid history of biopsychiatry in America, starting with the madhouses of the 1700s, which were quite literally torture chambers, where supposed “doctors“ used devices like the gyro chair, a violently spinning platform that forced blood into the heads of the insane, because some sadistic doctor had theorized that madness was caused by a decreased circulation to the brain. Not surprisingly, this method, which sounds so ridiculous today, resulted often in death, very seldom in recovery. But it did help to reduce the number of so-called lunatics walking the street.

 

Whitaker then contrasts that medically-endorsed barbarism with the gently humane approach of the Quakers in the early 1800s. The Quakers insisted that the mentally distressed be treated not like lepers, but rather like brethren. Gone were the dungeons of the asylums. The mad, the distressed, the depressed were welcomed into elegant homes situated on pristine grounds. No forcible restraints, no coerced treatment, no medications. The patients were allowed to roam the grounds and commune with nature, to listen to music, to go to classes and engage in social events. They were treated as humans and re-integrated into an accepting society. And they got better, sometimes not right away, but often for good. Tellingly, the Quaker approach developed from a spiritual tradition, in total absence of supposed science and medical doctors. Often, doctors weren’t even allowed onto the premises of the sanitariums. Mental distress simply was not considered a medical disease. It was a spiritual and social malaise, something that could happen to anyone merely because they had been born human, and with their low-key, empathic, humanistic methods, the Quakers cultivated some of the most remarkable recovery rates from mental distress in the history of our country.

 

So how did we fall away from that success to where we are today? After the Quaker period, a dark chapter arose, where the discoveries of Darwinism gave rise to the eugenics movement. Evolution and natural selections seemed to strongly suggest that the mentally ill carried defective genes, and thus thousands of the mentally distressed underwent forced sterilization, with the explicit endorsement of the US Supreme Court. Not surprisingly, due to society’s new conception of mental illness as a disease. the ugly era of the lunatic asylums returned with involuntary commitments, coercive and brain destructive treatments, naked patients roaming through windowless basements and slamming their heads into wall.

 

Eugenics had set the stage. Symptoms of mental disturbance were now seen as pathological disease states that must be quarantined from society and obliterated. Onto this prepared stage walked the brain-destructive treatments of ice-pick lobotomies (for whom its developer received the Nobel Prize), insulin comas and electroshock, all designed to destroy brain tissue, eradicate disruptive symptoms, and make patients more docile and manageable in the asylums and at home. If the patients cognitive abilities, personality, and very humanity were destroyed along with the symptoms, it was considered a small price to pay.

 

These brain destructive treatments, along with the advent of the miraculous power of antibiotic drugs for curing infectious disease, created the medical precedent and the social anticipation for a psychiatric drug revolution. The first antipsychotic drug was thorazine, developed initially as an anesthetic agent, and hailed by its manufacturer with the most glowing terms as a “chemical lobotomy.” Modern psychiatrists don’t refer to thorazine or its successors with those stigmatic words anymore, and yet our modern antipsychotics, for all of their supposed advances, work through the same mechanisms: they alter normal brain function, sometimes permanently, and create a numbing, dissociative effect between the suffering self and his or her symptoms. They do not, and have never, corrected a known chemical imbalance. But they do, in the short term, suppress abnormal or undesirable behavior and make patients easier to manage. Yet this short term tradeoff does not translate into favorable long-term outcomes, and it comes with a heavy price, both monetarily and in life-threatening side-effects. A recent study showed that medicated schizophrenic patients die on average two decades earlier than the general population. And that’s where we are today, an explosion of disability and early deaths among the mentally disturbed, getting worse and worse the more we medicate, a deadly iatrogenic epidemic.

 

So where are the Quakers and the humanists today? How did we, as a society, put the cynics in charge? Conferences like this, and people like you, are inspiring to me, because you are at the vanguard of a pendulum swing, a paradigm shift, helping to realign our science and medicine with our sense of humanism and empathy.

 

I think of mental health reform in terms of the human rights movement. What if American society had been persuaded that George Wallace and his narrow-minded segregationists were right? When the bigots attempted to suppress the civil rights movement, our society in response produced a courageous visionary, Martin Luther King Jr and other heroes, people who offered a countervailing dream, full of hope, brotherhood, and appeals to the higher moral law. Now, I wasn’t there, but I understand the Sixties were a rough decade. Change didn’t come without paying a great price. But MLK and the humanists prevailed, and less than fifty years later, we have an African American in the White House. Change is possible. It may be painful and slow and full of set-backs, but it starts with ideas based on human rights and compassion, it gathers momentum from courageous early adopters and visionaries, and then it spreads outward and upward into society, like leaven in bread.

 

Around the same time as Martin Luther King’s emergence, another amazing human graced the planet and wrote a foundation-rocking book, a book so brief and beautiful that it somehow has been overlooked, bypassed by supposed scientific advances, for its fundamental assertions about the nature of mental wellness. Ironically, this book about the glorious potential for meaning in a human life and even suffering, was written by a man, a psychiatrist, who witnessed and survived one of humanity’s most horrific atrocities, the Jewish Holocaust. I don’t know how I made it to my age and position without having read Victor Frankl’s classic, “Man’s Search For Meaning,” but I’m so glad that I finally did. I think this book should be required reading for every doctor and patient--make that every person--on the planet. We would all be so much better off if we understood what he was trying to teach us.

 

Frankl first describes his horrifying, dehumanizing survival experiences in Auschwitz and other concentration camps, and then details his philosophy and methods for coping with life by finding meaning in our experiences and even our suffering. Written over fifty years ago, the book is remarkably prescient in forecasting the cynical, mechanistic state of our current drug-intensive mental health system, and sums up perfectly my evolving observations as to the costs of turning to drug therapies at the first blush of mental distress, the cost not only in money and side effects, but also the opportunity cost to patients' humanity, to their ability to learn something valuable and essential from their distress that could enhance their sense of purpose in life. I want to quote extensively from the final pages of the book, because I find these words to be so pertinent to our predicament today.

 

Frankl said: "Not every conflict is necessarily neurotic; some amount of conflict is normal and healthy. In a similar sense suffering is not always a pathological phenomenon . . . suffering may well be a human achievement, especially if the suffering grows out of existential frustration. Existential frustration is in itself neither pathological nor pathogenic. A man's concern, even his despair, over the worthwhileness of life is an existential distress but by no means a mental disease. It may well be that interpreting the first in terms of the latter motivates a doctor to bury his patient's existential despair under a heap of tranquilizing drugs. It (should be) his task, rather, to pilot the patient through his existential crises . . ."

 

"To be sure, man's search for meaning may arouse inner tension rather than inner equilibrium. However, precisely such tension is an indispensable prerequisite of mental health. There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one's life. In the Nazi concentration camps . . . those who knew that there was a task waiting for them to fulfill were most apt to survive.

 

"I consider it a dangerous misconception of mental hygiene to assume that what man needs in the first place is equilibrium or, as it is called in biology, 'homeostasis,” i.e., a tensionless state. What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him." (2006 revised edition, pg 102-105)

A

nd finally, one more long quote from Frankl, the final paragraphs of this masterpiece, a section entitled Psychiatry Rehumanized, words written fifty years ago that are increasingly relevant to all mental health providers and patients today.

 

"For too long a time--half a century, in fact--psychiatry tried to interpret the human mind merely as a mechanism and consequently the therapy of mental disease merely in terms of a technique. I believe this dream has been dreamt out. What now begins to loom on the horizon are not the sketches of a psychologized medicine but rather those of a humanized psychiatry.

 

"A doctor, however, who would still interpret his own role mainly as that of a technician would confess that he sees in his patient nothing more than a machine, instead of seeing the human being behind the disease!

 

"A human being is not one thing among others; things determine each other, but man is ultimately self-determining. What he becomes--within the limits of his endowment and environment--he has made out of himself. In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.

 

"Our generation is realistic, for we have come to know man as he really is. After all, man is that being who invented the gas chambers of Auschwitz; however, he is also that being who entered those gas chambers upright, with the Lord's Prayer or the Shema Yisrael on his lips." (pg 133-134)

 

Amen, Viktor

 

For the past nine months, I have been writing a blog for Robert Whitaker’s site, madinamerica.com, about my changing perspectives on mental health. I'd like to conclude by sharing a recent entry.

 

It has been eye-opening to realize just how often I'm dealing with psychiatric issues. I have been keeping track, and I average between seven and ten cases a day in which the primary or secondary complaint is of a mental health nature. This means I am dealing with mental health more often than I deal with viral infections or hypertension, which are other staples of primary care. This is not a change. It seems that I'm just more attuned now to how often I deal with these things, whereas previously, foolishly, I dealt with them more as background noise.

 

Some of my patients are complicated with severe emotional or even psychotic disturbances, but those are rare. Most of my patients are suffering from what I would consider mild symptoms. Now, I recognize that from a patient's perspective, what I perceive as "mild" may in fact seem overwhelming. I'm not trying to diminish their subjective suffering. What I mean is that most patients do not show signs of a pathological disturbance. Rather, they are sad, lonely, anxious, frustrated, disillusioned, confused, scared--all in all, they seem very human, suffering from some of the mood changes that are endemic to the human experience. In the vast majority of these cases, major social and environmental factors are the clear precipitants of their symptoms: death in the family, job loss, marital struggles, substance abuse.

 

I sometimes have to ask myself, "Why is this patient coming to my office to seek my help with these problems?" It seems like their problems might best be addressed with a counselor, pastor, social worker, a friend, or even just reassurance and the healing effects of time, but in America, with the way our mental health and society has evolved, mental distress has been labeled a biological disease, and thus when patients suffer from emotional distress, they come to their doctor's office for help.

 

Most physicians are highly intelligent, trained to think empirically, trumpeting evidence-based medicine, driven to do what is best for our patients. And yet we remain curiously unskeptical about the purported certainties of the standards of psychiatric care. We believe so completely this officially endorsed version of reality, this biochemical model of psychiatric illness, that when a patient manifests symptoms that faintly correspond with five of the nine criteria for depression, we pronounce them diseased, slapping labels on them, and we feel justified, in spite of there being no evidence of physiological dysfunction. Then as a matter of course we hand them a prescription, certain we are providing them with the very best treatment available, even though there is no evidence of its long-term efficacy, and plenty of known risks.

 

Addressing root causes, advising patience and sharing perspective: these things are at best secondary therapies and are mentioned only superficially, because the real problem lies in the physiology. If we didn't think our pills were necessary, then why would we prescribe them? In this way, we witness our fondest aspirations being fulfilled. We have become a vital cog in the great wheel of modern science that is improving the human condition. We feel a sense of satisfaction as our patients, prescription in hand, offer us their gratitude, and this encounter is added to our mental database, confirming circularly that what we have done is right because, well, it's right, right?

 

And yet we are so wrong. In reality, we are slapping reductive labels onto patients, oversimplifying complex emotional and social issues that would better be understood as variances on the continuum of normal human experience. But these are differences, not diseases. We are giving them brain-altering drugs that may provide a short term benefit, but at devastating long-term cost. This has been my practice-altering epiphany: the patients I think I am helping are actually getting worse, developing damaged self-concepts, and becoming poorer and all too often disabled.

 

This is the reality of mental health care in America, and it is dismal, ultimately unsustainable. At the rate we're going, we'll all be diseased and disabled in another fifty years. By far the most distressing thing I have observed is how this destructive paradigm is affecting and disabling our children, an entire generation being raised to believe they are broken and require medicines to be well. I feel for these children who are being iatrogenically disabled, and I feel for the parents who are trusting in medical authorities and have been deceived.

 

But I haven't lost hope. I'd like to believe that there is an upward trajectory for the practice of medicine and societal intelligence, and that the truth will win out in the end. I hope that, with the awareness bred by conferences like these, doctors will lead the charge and create the change. This will be "Do No Harm" coming home to rest, putting the brakes on our runaway compulsion to intervene. “No, I may not be able to fix you with a pill, Ma'am, but at least I can refrain from making you worse.” Or as a wise mentor once put it, "Don't just do something, doctor, stand there."

 

Recently, I saw an adorable four-year girl who had been doing flips on her bed, fell and broke her arm. She was in a cast, and was very sad about it. As I talked to her, I became aware that she was sad because she thought she would have to wear this cast forever. No, I explained, you're just going to have to wear it for a few weeks, and then we'll take it off. She smiled at me. I said, Do you know what is so cool? Your bones are healing right now. You don't even have to think about it. What was broken and hurting you is coming back together, and when we take the cast off, it will be just as strong as ever, maybe even stronger. She thought this was very cool, and then she wanted her sticker.

 

It is so cool. Our bodies and minds want to heal. Often, they don't need a lot of help to do that, just time. We see so many things on TV and in the news, tragedies of disease, triumphs of medical heroism, and we have become deluded that doctors and pills and technology are what save the day. Sometimes we do. Some diseases, some mental illnesses, are severe, debilitating, life-threatening. But for most of us, and for most conditions, we hurt and then we heal, we suffer and then we recover. We need to remove toxic influences. We may need to use a cast, or a surgery, or a pill for a short while. But the impetus is towards healing and wholeness, and that happens spontaneously, for the body as well as the mind.

 

Here's hoping for continued progress towards that healthier paradigm of mental wellness.

 

Thank you.

--------------------------------------------------------------

Ten Guiding Principles

for Improving Mental Wellness

 

Developed by Dr. Mark Foster, DO

and Clear Minds

 

 

 

 

1) Empathic relationships, hope, patience and the healing powers of time are the most powerful therapeutic tools available to any provider, therapist, peer, or family member who seeks to help alleviate the real suffering that can be brought on by mental distress. Any drugs or other interventions that interrupt, supercede or supplant these therapeutic tools will ultimately do more harm than good.

 

2) The human brain and mind are irreducibly complex. The brain, with its trillions of synaptic connections, activates the body, mind, and spirit complex, yet the inscrutable essence that emerges from that nexus cannot be reduced to a series of biochemical events. The brain and mind will always be greater than the sum of their parts.

 

3) The human body, mind and spirit, when disturbed, possess the capacity to spontaneously heal, to self-correct and to self-regulate without external intervention. At times, external interventions may be indicated in order to facilitate or hasten healing, but even then, ultimate healing--a restoration of wholeness and wellness--is an intrinsic, internally driven process.

 

4) Mental stress, emotional distress and thought disturbances cannot be reduced to simplistic biochemical or pathological entities. There is no scientific evidence for the culturally accepted "chemical imbalance" theory. While biological factors certainly do affect our mental and emotional states, science has never elucidated a known disruption in normal brain physiology that correlates with an observed, reproducible symptomatology.

 

5) Adherence to the tenets and treatments of biopsychiatry and psychopharmacology has been physically, emotionally, and financially harmful to many millions of people and to society over time.

 

6) The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) is an ethically compromised, reductive and dehumanizing handbook. The diagnostic entities it purports to detail are compilations of symptoms and should not be considered authentic biological diseases or disorders. It should not be used to diagnose or label mental distress or thought disturbances. Differences are not diseases.

 

7) Psychiatric drugs are typically ineffectual and most of their perceived efficacy is due to enhanced placebo effect. They carry a tremendous cost burden of side-effects, mental impairment, financial cost, and creating a victim mindset. They produce a dissociative schism, both pharmacologically and psychologically, between the suffering self and his/her symptoms, and they interrupt what should be an organic restorative process. Drugs should be used rarely, if ever, and then only as a last resort, only for a limited duration, and only as an adjunctive therapy to other intensive and empathic lifestyle and counseling interventions. Psychotropic drugs should not be presented to patients as necessary to correct a chemical imbalance in the brain, but rather as what they are: brain-disruptive drugs that may temporarily alleviate severe symptoms when all other therapeutic options have failed, and then only when the possible benefits outweigh the known risks. They should not be used for long-term "maintenance" therapy.

 

8) Any therapeutic interventions for mental distress should have empathy and supportive relationships at their core. Therapies should be comprehensive in scope, addressing fundamental lifestyle and relationship issues. There is no "one way" that will benefit all individuals. Rather, a variety of disciplines and approaches should be employed, and therapy should be highly individualized with the client’s full input and guidance.

 

9) Patients must assume responsibility for their own condition and recovery. A provider, therapist, peer or family member’s role should be to encourage the patient to access their intrinsic healing capacity, and to walk beside them on their journey towards recovery.

 

10) Medical doctors should be decentralized from diagnostic and therapeutic approaches to mental distress, simply because there are no known biological disruptions or effective medical interventions. Peers, therapists, friends and family members should be the first points of contact and the first lines of intervention. Patients should maintain autonomy and ultimate accountability for their own recovery.

[Altostrata]

From Dr. Foster's mouth to the Deity's ears.

[Claudius]

These 10 points exactly address the whole matter. Oh my God, what if we had known this before quitting.... of even better, before swallowing....

I will include this with the letter I send to my GP. Although I hardly believe it will make any difference... it is not possible to convince flat-Earty believers in that the Earth is a sphere... Religion cannot be beaten even with the best arguments, and psychiatry is the worst and most evil religion ever.

[alexjuice]

Thank you for all of your work, cine, bringing Dr. Foster to the attention of the board. I, for one, was not familiar with him...

 

It's so great to see the cause gathering allies.

 

alex.i

[Altostrata]

What can you do if you don't take antidepressants? There are so many ways to make yourself feel better....

 

Posted on Robert Whitaker's Mad in America blog

 

As I share with patients my new perspectives on the ineffectiveness and potential harm of psychotropic drugs, I have found that many, even most people, are receptive to the idea. I'd say that about 25% of people are enthusiastic about it: "Yeah, I don't think those pills work anyway. Thanks for telling me."; about 50% are somewhat receptive: "Really? That's surprising, but it makes some sense. I'll have to read more about it."; and about 25% are highly skeptical of me, my suggestions, my motivations, my education, my sanity: "What do you mean they don't work? Of course they work, doc....They changed my life. You'll have to pry them out of my cold, dead hands." (I actually had someone say this to me! I chose to let the obvious irony pass.)

 

This is all fine. Everybody needs to feel comfortable within their own paradigm, and I don't expect everyone to agree with me, and I don't claim to have any privileged vantage point of the truth. Patients can find plenty of other doctors willing to prescribe them brain-altering medications, no questions asked. But overall, I find these numbers encouraging, because they indicate that about 75% of people are at least willing to engage with a non-pharmaceutical paradigm. I'm convinced that most of those who do, who take the time to read the evidence and consider the implications, who glimpse who is actually benefiting from the current model (hint: not them), will find their way towards more holistic solutions for their mental distress. I think most people intuit that there is something fundamentally wrong, reductionist, dehumanizing, with the current system, and they're looking for something better.

 

Which brings up a challenge all its own. Whenever someone comes to recognizes the harm and ineffectiveness of long-term psychotropic use, it invariably provokes this question: "Okay, pills aren't the answer. So what else is there?"

 

Trying to answer this question, I've found, can be both frightening and exhilarating. My natural inclination--my sense of myself as a healer--makes me want to satisfy my patients' expectations for quick and easy solutions. But I don't offer those illusions anymore, and I resist anyone claiming to have the "One Best Solution" for everything--especially if they are making money off of selling it. Not having a prescription pad in hand, that seductive promise of a one-size-fits all guaranteed solution, makes me feel vulnerable, ineffective, unfulfilled--even if I'm simply being authentic and realistic.

 

I remain hopeful. Hope makes answering the question of "what else?" exhilarating, illuminating. There are so many non-drug recommendations to make! Many of them are amazingly simple solutions, things people already know but just aren't doing effectively. I think the single most important thing I can help them with is the perspective shift, moving away from viewing mental and emotional distress as biological diseases worthy of eradication by harmful medicine, and towards an integrative approach that attempts to discern why the symptoms are occurring in the first place, what can be learned from them, what must change in order to restore a sense of wellness. This perspective is inherently hopeful, and embraces our bodies' and minds' intrinsic drive towards healing and wellness.

 

Below, I'm going to post a condensed list of a handout that I provide my patients. Some may find this list simplistic, and I agree that there are many instances when more aggressive interventions are indicated. But I believe the vast majority of people, if they put these suggestions into practice, would naturally, almost unavoidably, enjoy improved mental health and resilience. Not perfect everlasting happiness and ecstasy, mind you, but peace and purpose in their lives, a sense of wholeness.

 

Here's the condensed list (an expanded list is available at this link, http://www.markfosterdo.blogspot.com ). After you read the list, stick around, as I want to share a revealing case study.

 

Tried and True Methods For Achieving Mental and Emotional Well-being

 

(And none of them involve medications)

by Dr. Mark Foster, DO

1) Daily exercise. (If you do nothing else on this list, do this.)

• At least thirty minutes a day, everyday.

2) Eat healthy food

• Start with five fresh fruits and veggies a day.

3) Daily sunshine

• Get outside and enjoy nature.

4) Celebrate life

• Grow plants, have pets, be around children. Appreciate the miracle of life.

5) Daily meditation

• Breathe. “Spend less time as a human doing, and more time as a human being.”

6) Daily journaling

• Be a hero as you write the story of your life!

7) Daily supportive conversations with a trusted friend

• Seek out healthy, nurturing relationships. Be around people who inspire you.

8) Get plenty of sleep

• Get eight hours of sleep a night, and try a twenty minute power nap after lunch.

9) Seek service opportunities

• Forget about your own problems, and make a difference in somebody else’s life.

10) Fill your mind with positive messages

• Read good books, watch great movies, listen to uplifting music, try a "news fast."

11) Be creative

• Release the artist within. Leave your unique mark on the world.

12) Keep a positive attitude

• Hope for a better world and a better life. Never give up!

13) Integrate your feelings and thought patterns.

• We feel and think things for a reason. What can you learn from your mental distress? What can you change so that you feel more at peace? Don't become numb to life. Be fully alive and responsive to your emotions and thoughts.

14) Work with a trusted professional counselor, therapist or pastor.

• An empathic therapist can be a powerful catalyst for healing. Find one that works for and with you.

 

That's the list I hand my patients. It's not a panacea--there is no such thing. But hopefully it gives them some concrete actions to take and helps them reframe their symptoms as opportunities for growth rather than diseases.

 

....

I'm not so naive as to think my little handout can rescue all who are so lost within the system, so drugged and so distressed. But I am certain that lifestyle and perspective changes must be an essential component to achieving mental wellness. To try and achieve such a state without doing anything on that list? That's a recipe for failure. If we're taking someone whose mental status is in total disrepair, and if we have to start somewhere, start there, with lifestyle changes infused with a perspective of hope, an appeal to the mind and body's ability to heal.

 

But don't start with drugs. That's a dead-end street for so many. That seductive prescription so often becomes an excuse to ignore the fundamental problems, precluding the self-awareness and healing that would occur if only we doctors offered patience, perspective, empathy . . . and got the heck out of the way.

 

Mark

 

http://madinamerica.com/madinamerica.com/Foster.html

[Lulu]

Wow. This speech made my day. It gives me such hope that we can change things. He's a rare bird. Thanks so much for posting this.

[Fid]

One word: Profound