The harmful regimens of the regimented regime

My charming San Francisco psychiatrist friend on X, Joe Pierre, M.D., registered what appears to me to be a telltale complaint according to my feed this morning.

Doc Joe wants people to know that "regime" is not the appropriate word to describe a list of medications that a patient is taking pursuant to a doctor's prescription. "Regimen" is the term he demands, with very arrogantly presumed authority (regency?).

I did a quick study, because I've used "regime" myself, I'm not the only one, and I think I'm as educated as, or perhaps quite a bit more so than Doc Joe, when it comes to English language and rhetoric. Words are primary tools for me as a lawyer, even as drugs are primary tools for Joe as a (very political) psychiatrist.

Joe maintains that regimen, regiment and regime "...are different words with different meanings."  Well sure, but many words are different from each other or related in different ways, for different purposes, and to different extents. The Doc might know this, but his native language (psychiatrese) could cause the principle to be very difficult for him to apply in English.

Just a few examples are instructive. 

Cat (the feline mammal and common house pet) and cat (the large earth mover manufactured by Caterpillar Tractor Company) are "different" words which sound and are spelled exactly alike; the same can be said of benefits (plural noun) and benefits (present tense of the verb), although these two "different" words are close forms with related meanings, unlike cat and cat; spring (the astronomical, meteorological or calendar season) and spring (a device which expands and contracts with increasing resistance or a sudden motion considered to be characteristic of such a device), or rose (the flower) and rose (past tense of the verb to rise) are further examples of pairs of words that are clearly different yet spelled and pronounced identically.

Yawl and y'all, shoe and shoo!, red and read, sew and so, and a long list of homophones, are words which sound exactly alike, but may be spelled differently and completely disrelated for meaning.

Individual small, common words may have similarities or differences that are purely a function of grammar (rules and habits of use), but they are not close at all in pronunciation or spelling. E.g., pronouns like me and I, she and her 

Machine, machinery, machination, mechanical, mechanism, and machismo are words that have similarities in meaning, spelling and pronunciation, as well as common derivation, but they remain different words, very much like regimen, regiment and regime. 

I took one semester of linguistics at Northwestern University, as well as German (I was briefly almost fluent) and Russian (a beautifully complex language). The subject of words is amazing and probably as complicated as the human mind itself. "In the beginning was the Word, and the Word was God," as (I think) the Bible says.

Which brings me back to Joe Pierre's "different words" regimen, regiment and  regime, three words which are closely related and commonly derived from the Latin regere (to rule). Regimen and regime have incidentally been almost interchangeable in historical usage. So what exactly is Doc Joe's point?

The San Francisco psychiatrist doth protest too much, methinks. It's emotionally difficult for him to hear or read psychiatric practices or treatments being called regimes. That word may recall or just come too close to, e.g., despotic governments like Saddam Hussain's Iraq, Putin's (or Stalin's) Russia, Hitler's Nazi Germany, and Jefferson Davis' Confederate States of America. Thus for Joe, regimen is much preferred, as long as you don't err by adding a "t" to the end of that word, giving it a military connotation.

In fact, psychiatry is a despotic regime. It is perhaps the most despotic regime in human history. The so-called "treatments" which guys like Joe Pierre militaristically order are horrendously damaging, and they are forced on thousands of people against their will everyday, people who have never been convicted of any crime, people kept, exploited and abused as psychiatric slaves!

I've spent twenty years fighting this despotic regime, at Elgin Mental Health Center, in cruelly regimented "clinical" units, behind locked security doors guarded by uniformed thugs and despotic "administrators" who hear, see and speak no evil until they are sued for millions of dollars in damages.

Too bad Joe, if you don't like my words for your f***ing psych regimen. Go look the words up in a dictionary, man. They all work!

Psychedelic Renaissance or a new drug dark age? (Ruminations)

Hundreds of Ketamine "clinics" have sprung up across the country; Business Wire PR statements celebrate FDA designation of various psychedelic drugs as "breakthrough therapies" to allow pharmaceutical company trials with acid, shrooms, and ecstasy, as promising new cures for various mental illnesses; LSD flows again in the streets and through the veins of American youth, to start the walls breathing and wake the sleeping demons.

As many people know, at the end of the 20th Century psychiatry's hot new drugs and great, vaunted "Decade of the Brain" all failed miserably. The theories and "diagnoses" were revealed as nonsense, and the "medicine" (only laughably called "antidepressants" and "antipsychotics") is now popularly recognized as abuse and snake-oil poison rather than science. People who do not want their life expectancy to be reduced by twenty years refuse psychiatric drugs, and the men in white coats may finally lose their legal facility to coerce anyone to be an unwilling patient. These developments amount to a dire threat to a scam profession, which once believed it had locked up the invaluable status of "medical specialty."

The threat might only be handled or lessened, if new and better "cures" for human problems in thinking, feeling and behaving can be miraculously developed. Two possibilities are: 1) new drugs, and 2) a resurgence (or actually an advent) of effective talking therapies.

Enter the so-called "Psychedelic Renaissance," which may bear directly on either or both of these two potential saves for psychiatry.

Psychedelic drugs do create huge effects on thinking, emotion and personality. Those effects can seem good or bad, they can make you think you're a holy superman or quickly kill you. But for psychiatry (especially American psychiatry), the drugs all by themselves are an obvious "Hail Mary" play. They do something.

But nobody knows what they do. Do they bring new brotherhood with the universe or horror and suicide? The answer is far too unpredictable, thus inspiring a regime called "Psychedelic-Assisted Therapy" or "PAT". PAT consists of two or more sessions with a trained therapist before and after a person trips on the drug. The preparatory session attempts to evaluate and optimize aspects of "set and setting" so the person will be more likely to have a "good" trip. The sessions after tripping help with "integration," or a hoped-for useful assimilation of the unusual and occasionally ("bad" trip) traumatic experiences caused by the drug. 

There is a great deal of speculation about this talking therapy element of PAT, whether it's necessary, how it can be standardized or researched, and whether it presents risks of abuse. "Set and setting" (respectively, the mindset of the person who trips, and the environmental influence when he trips) was researched in the 1950's and 60's. Arguably, the concept of set and setting has not changed in almost three quarters of a century; the knowledge that these factors are the largest determinants of a person's experience with psychedelic drugs, which clearly cause a state of hyper-suggestibility, has not changed.

Of course, the orthodox, APA-type psychiatric establishment gave up on helpful psychotherapy long ago. They became a medical specialty instead, brain doctors, under the arbitrary, vain presumption that all the secrets of life can eventually be found in the brain. Psychiatrists thus fell under the economic whip of health insurance actuaries and capitalist third-party payers. So they cannot officially push PAT, and they can't really push psychedelic drugs alone, until those drugs are proven safe and effective (which may never happen).

The current rage for LSD, ecstasy, shrooms and special K, comes from a weird collection of people who call themselves the Psychedelic Renaissance. They've raised a lot of money and bought some success, e.g., with state legislatures in Colorado and Oregon, and with European and Australian drug regulators. However, they recently had an epic failure with the FDA in Washington, D.C.

The most high profile organization in this weird collection is the Multidisciplinary Association for Psychedelic Studies (MAPS), headed by 71-year-old Rick Doblin, a charismatic Harvard Ph.D. MAPS and Doblin have historical ties going back to the original psychedelic movement in the mid-20th Century, but they don't talk much about that. They are covert religious fanatics, but their public focus and the image they carefully cultivate is of 21st-Century scientific research into sorely-needed treatments for mental disorders, and potential improvements in people's mental and emotional lives.

The falsity of MAPS' PR image is obvious in a single, stark contradiction: psychedelic drugs are promoted as both scientific medicine and religious sacrament. Tripping is (simultaneously) treatment for brain disorders and a religious ritual for spiritual revelation.

The Psychedelic Renaissance is a weird group of people mostly because they strategically believe one or the other of these contradictory things, at different times and in different circumstances, and pretend not to notice any problem. As a movement they promote both views because if tripping isn't medical treatment that private insurance or Medicaid pays for, it will never be scalable or show profit. Talking psychotherapy is expensive, and even if it ever did work, it didn't appeal to regular people, just the wealthy. Broad, booming, popular interest goes to big things, prospects for true breakthroughs: life-changing expanded consciousness, brotherhood with the universe, victory over death. 

Tim Leary was a trained scientist who found deep faith in LSD. Ken Kesey was a bratty college kid who cared about nothing but "pranking Amerika." They were both apparently part of the same movement. But a lesson of history warns us to notice differences better than we did then. The good trip of 1967 music and love all too quickly became the bad trip of Watergate, Manson murders, and Jonestown. By 1970, hippies were (quoting Jules Evans' and Steve Rolles' charming characterization of present-day psychedelic drug enthusiasts) "boring dickheads."

Generations ago, Western culture was alive and powerful enough to survive psychedelics, but it might not be so resilient now. We must pay closer attention, and above all we cannot any longer alienate an honest study of the mind from religion; we cannot condone the degenerate parody of such honest study in non-religious fields. 

We cannot be so suggestible, as to be hypnotized into the weird idea that we are nothing more than a brain. 

"Set and setting," brother. Peace!

More on sex with mental patients

I have to hope I didn't give a wrong impression, in my June 1 article. Just to be sure, I'll briefly clarify a couple things here.

I absolutely do not believe that institutional staff have any slightest excuse or justification--EVER!!--for seduction and sexual abuse of mental patients. This is severely harmful abuse, which ruins lives! It's also a crime, which people have rightfully gone to prison for. More people will probably go to prison for this crime, and they should! It's similar to child sex offenses, equally despicable.

My point in the recent article was just to ask readers to think a little more carefully about why.

People clearly need to think more carefully about why, because all the rules and laws and threats of prison do not prevent some portion of mental health professionals from crossing boundaries. It's a chronic problem that has never been solved. The complexity itself is proof that nobody knows how to solve it, and a constant warning that these terrible violations will continue to happen.

My point, which I tried to explain in the earlier article, is that it's far too easy to bury your head in the sand. People convince themselves that they don't know things they don't want to know. But they do know those things, and I will continue to sue them until they admit they know them, and until they think more carefully about why. 

It may or may not require the total abolition of psychiatric slavery, or the fundamental redesign of legal and social institutions which are supposed to deal with dangerous and obnoxious people. I don't know.

But I sure as hell do know that none of us can simply show up for work and try to stay out of trouble every day until we can collect a pension. We have to think more carefully.

That's the only way the harm will ever stop.

FDA panel says NO to medical ecstasy!

Yesterday the Psychopharmacologic Committee of the U.S.Food & Drug Administration voted 9-2 to decisively reject purported effectiveness of MDMA "treatment" for PTSD, and 10-1 to overwhelmingly find that any benefits of such "treatment" are outweighed by the risks.

I put quotation marks around "treatment" because the committee's findings highlight the embarrassing fact that the people pushing this whole thing never did figure out what MDMA-assisted psychotherapy, or any other psychedelic-assisted psychotherapy, actually is to begin with.

Some like to believe it's the pill that actually cures PTSD. The drugs are catalysts to scramble a brain/mind in such a way as may effectively force a new and better point of view in a patient, who realizes that his/her past trauma is unimportant in light of the vast existential connectedness experienced while tripping, which would surely save the world if only enough people could turn on, tune in, and drop out.

Oddly perhaps, the only apparent theory behind electroshock treatment is similar: a patient gets hit with force violent and painful enough to make him/her look differently at less impressive things. 

But recall (if you're old enough) the dramatic appearance of three huge letters on a hillside in Berkeley, California where high school classes had traditionally painted the name of their school or class year. As 1967 opened, the only message on that hill was: "L... S... D". Psychedelics were mystical messianism from the beginning, never scientific medicine. Flowers and amazing music came with the drugs, so the whole thing had an aesthetic appeal which ECT severely lacked.

And these days, bureaucrats at government agencies are prone to think the drugs do little or nothing by themselves without some talk therapy (although they can't say what kind) or psychological work. The preparation before tripping, and the integration sessions afterward, are essential. Without the psychotherapy element it's not safe or effective.

The FDA monitors and regulates food and drugs, not psychotherapy. They also had to notice certain implications of data (and omissions of data) from the trials cited in the presentation to their committee yesterday. These might make them very happy that they don't regulate psychotherapy. Boundary violations are a larger problem when patients are so suggestible on drugs like MDMA. 

But the truth is it has been more than a generation since psychiatrists even tried to be any good at talking therapy. If they're going to get back into it now because the "decade of the brain" was bullshit and all the antipsychotic and antidepressant drugs failed to solve the problems of humanity, they'll have to start almost from scratch. Handling the patient who's freaking out on LSD or confronting demonic entities on psilocybin is more or less the opposite of starting from scratch!

These guys don't even know not to evaluate patients' conclusions and thoughts for them (they think that's what they're supposed to do as the experts!), and they don't even realize that acknowledgement is a critical part of two-way communication. They're just as likely to kill productive therapeutic realizations with veiled criticism or skepticism, as to enable them by appropriately professional manners.

So at best they end up controlling people, not helping them. Psychedelic drugs certainly assist with (vicious, covert) control, basically by wiping out people's self control.

The MAPS/Lykos/Doblin crowd will hate yesterday's FDA hearing result, and they'll moan sadly about the urgent need to advance new and better therapies for the terrible problem of PTSD. I on the other hand will hope that yesterday was the first sign of the complete demise of the celebrated "psychedelic renaissance"!

These guys want money and control; they have no clue how to help, and psychedelic drugs will never be better therapy.

Sex with mental patients

Sex is a fundamental expression of humanity. In fact, it's a fundamental expression of being alive in a broader context than just humanity. Animals, and even plants, have sex. It's not unreasonable to assume that their sexual expression is as important to their life as human sex is to people like mental patients, social workers and security therapy aides.

Humans have the power to control the sexual expression of less evolved life forms, and we frequently do so just for our peculiar advantage, or if their sexual expression happens to become offensive or inconvenient to us. My dogs are neutered, and my new Ginkgo tree has been genetically engineered to not produce the fruit that would rot and smell bad in October. But why would a fundamental expression of life become offensive or inconvenient? The fact that it clearly does implies some some very basic misunderstanding or disagreement with life itself.

We all want to be as fully alive as we can be. This is the whole impetus of evolution. Human beings developed language, advanced social organization and culture; and we have learned (or at least continuously attempt) to master matter, energy, space, and time itself, in the pursuit of being more alive. That is our game.

But something... maybe about the strategy we are on to win this game, or maybe about the rules, or maybe about an opponent... is mistaken. The facts of sex and our confusions about sex prove this, and urge us to think more carefully.

Why exactly is sex with institutionalized mental patients wrong?

We have so many rules and explanations, and justifications and arguments and theories, which in the end just do not solve the problem: there must be sex but there can't be sex. The problem is nowhere so obvious as at Elgin Mental Health Center and the other nuthouses operated by the Illinois Department of Human Services.

Supposedly EMHC is, "A hospital dedicated by the State of Illinois to the welfare of its people for their relief and restoration, a place of hope for the healing of mind, body and spirit, where many find health and happiness again." That's what it says on the handsome bronze plaque on the wall, right?

Well, certainly sex is part of anyone's version of health and happiness. Why must it be so severely regulated? Why is it banned between patients and staff? Why is it dangerous?

There are people who need to heal mind, body and spirit, and who need to find health and happiness again. In the hospital those people are not supposed to be allowed real sex, and the rules about that are supposed to be helpful to them. There's a whole lot of disagreement though! Most of it is hidden. So what's this complicated story all about?

We create institutions, organizations, social and cultural structures... as evolutionary strategies. Psychiatry, or the medicalized "healing" of human problems in thinking, emotion and behavior, is one such structure or strategy. No strategy is ever perfect by the way, that would make the game be too easy and boring, or it would just be over too quickly. The main point with a strategy is to continuously improve it until the current game is won and a new game becomes available.

All the rules about sex between staff and patients are part of the strategy of medical psychiatry. Other parts of that strategy include the conceptual location of human problems with thinking, emotion and behavior exclusively in the brain and the apotheosis of the brain itself, the use of drugs and other somatic tactics (ECT, etc.), the subordination of other specialized knowledge (psychology, social work, religion) to psychiatry; the prioritization of public funds for what we call "mental health," the shaming of anyone who might be called "anti-psychiatry," and the establishment of legal and financial advantages for pharmaceutical companies and medical enterprises. It's a very big socio-cultural machine, and everybody is supposed to be competent to use it and responsible for getting it repaired when a need arises.

But our civilization has forgotten that this is all a strategy and a machine to be used in the game of life. People believe it's just true. That's why sex is such a big problem: it points insistently to the fact that we sorely need to improve our strategy. Sex embarrasses us. Or maybe (more significantly) it shows that we are missing some of the rules to this game, or that we cannot even identify the goalposts and the opponent.

Of course, we have been repeatedly embarrassed by sex throughout human history. (Think Trump and Stormy Daniels, Mata Hari, Giacomo Casanova, Caesar and Cleopatra, Helen of Troy, and Eve!)

In the more specific history of psychiatry, practitioners were frequently embarrassed. Freud's psychoanalysis was originally billed as science, but it was never popular and available except for repressed rich people who wanted salacious stories. By the 1970s, psychiatry had to renounce libido in favor of neurochemistry to remain a medical specialty that paid well. In the 1980s and 90s, they had to renounce an overwrought minority of their own guys who were pushing a weird theory of multiple personalities caused by satanic, ritualistic sex perpetrated against children by international cannibalistic conspirators supposedly lurking in everyone's neighborhood. (Think Bennet Braun, M.D., and Rush Presbyterian St. Lukes!)

Now they have to disavow state employees proven to have seduced and sexually abused the mentally ill people at their mercy, or other employees proven to have enabled the seduction and abuse. These employees are all supposed to be above suspicion, so they are much more of an embarrassment as professionals who have supposedly dedicated their respective careers to working in mental health facilities, and would never jeopardize their own careers and morals.

It turns out that it's much harder to control the sexuality of human beings than that of house pets or trees. And if we try it's dehumanizing, especially when we fail, which is almost always. We have to pretend that there is no sex between staff and patients at EMHC, or that it's vanishingly rare. Otherwise, this strategy that we call psychiatry has to be seriously questioned.

Psychiatry would be revealed as a fundamental misunderstanding or disagreement with life itself: a bad strategy for the game. We don't want to know that, we have too much invested.

It would be too much work to improve or abandon the strategy.