Justin Garson
@justin_garson
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THE MADNESS PILL ( @StMartinsPress forthcoming) | MADNESS (Oxford 2022) | Philosopher, CUNY | words in @PsychToday @aeonmag @Mad_In_America | rep @Vogelrachelm
New York, USA
Joined May 2022
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This was hard to write. I wrote for Aeon on seeing mental illness as purposeful, not pathological, and about the experiences with my dad that led to this shift. I’m grateful to Christian Jarrett
@psych_writer
for careful editing. Comments open
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Anyone who’s spent time on a psych ward “gets” the basic mechanics: you’re forced to comply with low-level, frustrated, and often sadistic staff. Reasonable outbursts against your treatment are seen as signs of pathology, and used as grounds for drugging and more confinement 1/5
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If that happens too often you're put in long-term ward. Ultimately, you realize that survival on a psych ward isn’t about “getting better”. It’s about learning how to comply with the demands of perfect idiots. (My dad had the same kind of experience in public mental hospital 5/5)
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Here’s an example from my experience in an adolescent psych ward. Patient 1 is sharing about a friend who committed suicide. Patient 2, who had the same friend, gives her a hug. A staff member says they broke the ‘no touching’ rule, and they can’t leave ward for 3 days. 2/5
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Patient 1, enraged, screams at staff member, is restrained and put in isolation. Patient 2, enraged, is also restrained and put in isolation. Two more patients put in isolation, general agitation ensues. One patient in isolation harms himself to express his anger 3/5
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The next day the staff member decides he will not punish them. But if you are put in isolation, that’s taken as a sign of a serious mental health problem, meaning the doctor will likely tack on another two weeks to the total duration of your stay. 4/5
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When philosophers say “I don’t do metaphysics” what they mean is “I inherited someone else’s metaphysics and I don’t want to think about it.”
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I think psychiatry robs us of our humanness. Depression, anxiety, panic, even psychosis, aren’t diseases, but very human responses to the problems of life. The answer isn’t more pills but targeting the social forces that make our lives so shit.
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Wonderful, groundbreaking research, led by my friend Hans Schroder, shows that framing depression as purposeful, not pathological, has better therapeutic outcomes. Continuing to promote the dysfunction/disease/chemical imbalance paradigm is becoming a serious moral problem.
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Antidepressants are literally robbing our generation of one of the few great things life has to offer. People should be more angry about that. Like out in the streets angry.
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Here's the real damage done by the serotonin hypothesis. It's not so much to people with depression - many benefit from SSRIs. I was on Prozac as a teen and it helped me out. The damage was how it shaped public imagination about mental illness (1/6)
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@MichaelALewis10
I’m glad you had that experience. I wonder how much anything ever changes in a system where you have a small group of people who have pretty much absolute power over another group of people, and almost no accountability.
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A hypothesis: as more people start to see mental disorders as coherent responses to life experiences, rather than brain dysfunctions, that’s going to have a destabilizing effect on psychiatry. I might be wrong about that. Time will tell.
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I think depression is sometimes just a great ‘no’ to the conditions of life. And the worst thing you can do is try to convince someone that something’s wrong with their brain instead of acknowledging that the world/their situation/etc is fucked and they are correctly seeing that.
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@BrandyLJensen
The thing I always come back to is: people don’t write stuff like this because they think it’s true. They write it because it’s a novel ‘take’ in an increasingly crowded market.
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@meanunclejack
Went to Uganda this summer and really miss spending the first 10 min of any interaction celebrating each other and asking about the family
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I’ve been writing about philosophy & madness but hesitant to talk about my own history with psychiatry. But not talking promotes the idea that madness and “mental illness” is shameful or impolite to discuss. So here’s my story 1/7
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A career in academia: fluctuating almost daily between near-manic excitement about a new project and its potential impact, and the overwhelming feeling that your work is unoriginal, uninspired, fruitless and wasteful.
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At root, what I dislike most about psychiatry is this: you have a person (the psychiatrist) who comes along and, in effect, says to another (the patient): “my grasp of reality is superior to yours.” No justification, no explanation. As a philosopher, I find this intolerable.
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Setting the record straight. The difference between continental and analytic philosophy is that it makes sense to get high and read continental philosophy (Foucault, Cixous…). But nobody gets high and reads, say, Kripke.
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There’s nothing wrong with scientists changing their minds. That’s how science works. There is something wrong with dumping billions of dollars into a false belief system and creating a warped idea of how madness happens. That damage will take a lot of time to undo (6/6)
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I’ve spent years trying to abolish my anxiety. The only thing I never tried is to befriend it. Goodbye pills
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A friend of mine told me that one of his first academic talks was severely criticized by a senior academic, and that night he went back to his hotel and considered killing himself. And I wondered how many people this happens to.
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I don’t think having a medical degree gets you one step closer to understanding mental health & illness. It just generates the appearance of authority, the reassuring illusion that someone in the room knows what’s wrong.
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My main goal in academia is to fight the dominance of the biomedical model of psychiatry through philosophical exploration of alternate paradigms, writing about psychiatry’s history & getting the word out about newer approaches 7/7
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I interviewed an extraordinary psychiatrist who practiced asylum medicine before antipsychotics. In 1950 he opposed putting schizophrenic patients into insulin comas, as it was useless and often deadly. His colleagues called him ‘reckless’ and ‘irresponsible’ for criticizing it.
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I went to a talk earlier this week by two psychiatrists who joked that, if they told patients all the risks of SSRIs and how they scarcely outperform placebo, nobody would take them. My sense is this is pretty much an open secret among professionals.
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I love psychiatric ads from back in the day. They were just so honest. No “chemical imbalance” BS. Just “you’re trapped, life sucks, take this pill” (1967)
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I wrote for
@PsychToday
on evidence that ADHD is designed, not disordered. ADHD traits are overrepresented in nomadic and migrating populations, which suggests cognitive benefits in environments that reward exploration, novelty-seeking, and movement
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When I was 1, my parents changed my name from “Paul” to “Justin”. Even today it strikes me as one of the strangest things I’ve ever heard. Has this happened to anyone else?
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I just read an overview of evolutionary aspects of schizophrenia. The author refused to discuss childhood adversity for fear of blaming parents. They spoke only of genes, infection, urban living...I worry that fear of blame, while important and serious, now impedes research.
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When it comes to the failed serotonin hypothesis of depression, people are looking for someone to blame. Who let it take over our thinking? I want to suggest something radically different. The problem isn't in the first place a specific person or group. It's an ideology (1/11)
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I don’t mean to be controversial, but sometimes I think being a philosopher is the best job on the planet. My job is literally to think about stuff, and sometimes tell other people what I’m thinking about. I feel grateful every day I get to do this.
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Book that was so disturbing you couldn’t finish it? (Naming and Necessity doesn’t count)
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It fostered the idea that forms of madness are just questions of “too much/too little” of brain chemical X, and that there’d be a simple chemical fix. For folks who didn’t grow up in the 80s, it’s impossible to overestimate the way that these ideas channeled research (3/6)
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Very powerful book by a psychiatrist and evolutionary theorist. Thesis: a small proportion of people are “designed” to interact with the spirit world - to be shamans. In small communities this can be an invaluable social role in providing direction and unity in trying times 1/2
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@gurevitchesque
I’m glad the story ended well. But for every person like that who had friends and relatives to hold staff accountable, there must be dozens of people who have no one to help.
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Genuinely confused about why this post enraged so many people
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I sometimes wonder if our preoccupation with mental health is making us worse. It’s just one more thing to be anxious about, to spend money on, to fail at.
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I wrote for The Philosophers’ Magazine on the emerging gap between philosophy of psychiatry and philosophy of madness: one reflects on the norms and assumptions of a medical specialty; the other uses madness as a window onto reality
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Many of us stopped seeing therapists. Even now, I have 3 different psychotropic prescriptions & haven’t talked to a therapist for 10 years. Many who went to med school in the 80s were indoctrinated into the chemical imbalance theory. All that mattered was your brain chemistry 4/6
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It’s kind of like the human genome project. Throughout the 90s we were told that once we sequence the human genome, precision medicine for nearly every conceivable disease was right around the corner. Of course, that promise never materialized (5/6)
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I’m a big fan of reading the work of people you seriously disagree with. If they’re right, it’s a good occasion to modify your views; if they’re wrong, you’re able to see more clearly where they’ve strayed from the truth.
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In the 80s, the serotonin hypothesis, along with the (equally simplistic) dopamine hypothesis of schizophrenia, fostered in the public imagination a certain idea about which sorts of therapies would work, and which sorts of therapies we should throw our money toward (2/6)
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Sometimes people say “how would you know anything about psychiatry, anyway?”
The idea that I’d have to be on the psychiatrist side of the relationship to “know anything about psychiatry” is part of the problem I’m fighting against.
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I mean, I like reading Foucault…but does anyone else feel like he just makes shit up as he goes along?
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I wonder if the social panic over suicide makes people worse off. I think there’s something very human about contemplating suicide and it doesn’t always mean you need to be locked up or stuffed with antidepressants or forced into therapy (all things that happened to me btw)
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Sometimes my work puts me in touch with exceptional individuals. One of those, whom I had the pleasure of interviewing this week, is neuroscientist/psychiatrist Solomon Snyder. One of his colleagues described him to me as a "f*cking genius" and I was not disappointed 1/6
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Seems not everyone understands the term “philosopher” is correctly applied to anyone who teaches and/or writes philosophy for a living. It’s kind of like “carpenter,” “musician,” or “lawyer.” It’s not narcissistic to call yourself a philosopher if you are, in fact, a philosopher.
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@LauraDelano
Interesting. I suppose I was pretty easy-going, and good at following orders, too. I made it up the “ranks” pretty quickly and got to enjoy privileges like going outside for lunch.
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Shocked and saddened to hear Dan Dennett died. He was one of the kindest, most generous, and genuinely inquisitive philosophers I’ve known. There was nothing of pretense in him, and he was always genuinely eager to talk about interesting ideas. There was nobody like him.
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Whenever I ask mental health professionals, what’s the number one way to help people with “psychosis” or other serious, distressing mental health crises, the answer is always the same: Community. Relationship. Listening. Being there. How have we forgotten such a simple truth?
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My entire emotional life is colored by the vague belief that I don’t have a right to exist. It affects my posture, my intonation, my writing. If it were possible to excise that belief the way you’d excise a tumor, life would be far different.
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One reason I like internal family systems is that it’s not about trying to ‘change’ yourself, but giving the various parts of yourself the space to be. What if my anxiety or fear isn’t a symptom of a disordered mind, but a part of my being that demands to be heard?
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It’s hard to call for a paradigm shift away from the disease model of mental illness without saying what we should shift *towards.* So, in a few words…what’s your alternative?
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“It is time to offer service users a genuine informed choice about whether to take on a psychiatric label…it is no longer…justifiable for professionals to insist on psychiatric diagnosis as the only way of describing people’s distress” Lucy Johnstone 🤯 👍🏻 💯
@ClinpsychLucy
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Any philosophers ever look at your writing output and think, “why am I doing this? I mean, what actually is the point?”
If so, do you have an answer for that yet?
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Powerful
@Psychtoday
piece by
@readreadj
: “Today, when we experience severe levels of distress and grief…we deserve better than scientifically meaningless, medical-sounding labels that wrongly imply there is something biologically defective about us.”
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As some of you know, I recently decided to stop taking anxiety meds and learn to befriend my anxiety. Yesterday I had a small victory. I felt overwhelmed with anxiety connected to a situation my kid was in. Instead of trying to ignore it, or worse case, pop a Xanax…(1/3)
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History of science is dangerous business. You can’t read for too long about the succession of brilliant, well-confirmed theories that turned out to be completely false - or fringe theories that turned out wildly successful - before casting a wary eye on all human knowledge.
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I hate anxiety. I’ve tried everything: therapy, self-help, pills, even befriending it. Now I’m done. Anxiety, we are foes. I will crush you.
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I recently quit 3 anxiety related medications. For me, it was absolutely the right choice. A few weeks in *it* returned: a vague sense of apprehension, even dread, settled over parts of my life. Certain people and situations assumed a menacing tone they hadn't before 1/7
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The key conceptual problem of psychiatry is, as I see it, the basis of its authority to classify, diagnose, restrain, and manage the mad. Yet I believe that recent historical and economic factors have obscured the very meaning of the question.
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When I was growing up, when a psychiatrist said “you have this mental illness,” we were like “f*ck off, you’re not a real doctor.” Now it’s like “oh my God thank you so much, now everything makes perfect sense.” What happened?
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Finally got to ask Dennett the question philosophers have wrestled with for decades: if I had the bat-like power of echolocation, would I still be human?
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People often feel relieved & comforted by a psychiatric diagnosis, but I think it’s, by and large, a false comfort: the comfort of thinking one’s problems have been explained or illuminated, rather than just redescribed in medical jargon.
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I asked
#ChatGPT
to explain Derrida’s concept of différance to me as if I were a 10-year-old child. I’m impressed and, to be honest, a little frightened. Be sure to read all 3 (1/3)
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That psychiatrists are getting furious, once more, at
@JoannaMoncrieff
for actively exploring ways to help people live well off antipsychotic drugs – given the awful toll they can take on one’s body and mind – just illustrates how small-minded and corrupt the profession can be.
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Finally reading, at a student’s insistence, Mark Fisher’s Capitalist Realism. One of his ideas is “gestural anti-capitalism”: the way capitalism tends to incorporate (i.e. profit from) anti-capitalist critique. I think a whole book could be written on “gestural anti-psychiatry.”
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Watched No Country for Old Men again and always stunned by this line:
“If the rule you followed brought you to this, of what use was the rule?”
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I wonder what happens when a whole society is led to believe that their emotions are problematic, disconnected from reality, and, quite possibly, symptoms of a brain dysfunction. It would be a society that’s paralyzed; a society that lives in an infantile state.
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Whenever psychiatrists complain here about “antipsychiatrists” I just replace the phrase mentally with “harmed service users” and everything clicks into place.
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Excellent paper by
@JTAuthor
arguing most cases of depression are functional responses to circumstances, not dysfunctions - as most cases of pain are functional responses to bodily harm. This is crucial for healing, as it points us outward, toward the world and how we view it.
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Philosophers, esp. philosophers of science, often feel insecure next to scientists. There’s a sense of “what can I contribute to this conversation? Scientists are doing the real work.” One response is to make philosophy look more like science. I think there’s a different way 1/3
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As philosophers of science, we really relinquished our duties under Trump. In our rush to insist that “science is real” and we should “trust scientists,” we forgot that part of our whole job is showing how science emerges from a blend of facts, values, and hidden paradigms.
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Just finished
@JDaviesPhD
’s Sedated: How Modern Capitalism Created our Mental Health Crisis. An important book, beautifully written.
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I’ve talked to a lot of people who think framing depression (alcoholism, etc.) as a disease is *good* because it gets you away from seeing it as a character flaw/moral problem. And that always struck me as a terrible, terrible dichotomy.
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It’s incredible to me that we still talk about ‘personality disorders’, as if your personality could be warped or diseased. It’s hard for me to imagine there was a time when someone thought that was a good idea.
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I’m starting to question the very concept of ‘delusions’: the very act of labeling you as delusional implies a superiority on my part - that my grasp of reality is superior to yours in a way that does not merit argumentation. Why would that ever be an appropriate stance to adopt?
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Amazed and saddened by the number of small-minded mental health professionals who came at me for this. Who feel certain their culturally-conditioned grasp of reality is superior to their patients’. Who never wonder whether their patients have special insights that they lack.
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In some ways, Twitter has been quite healing for me. I grew up thinking that, when people got angry at me, I must’ve done something terribly wrong, and I’d try to fix it. Now, I can see that people get angry at me just for stating my opinion clearly, and I’ve come to accept that.
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I used to think of insomnia as a terrible curse and took sleeping pills for years. Part of healing has been accepting it. For example, last night I woke at 3am, got up, had an valuable insight, and fell asleep. Maybe some truths only make themselves known in the dead of night.
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One of the most harmful aspects of the idea that “psychiatry is a branch of medicine” is you feel like you need a degree in order to be a supportive ear for someone, to hear them out, to offer encouragement or advice. Psychiatry corrodes an essential element of human relatedness.
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Yes I bought these last week and yes I know I have a problem with books.
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How can a doctor in good conscience say: “so, you’ve been sad and anxious, I think you should try this pill. 50/50 chance it’ll hurt your sex life, maybe permanently, benefits are placebo-driven for most folks, and there are proven alternatives like talking or exercise, but…”
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