Article archive / February 1, 2014
Originally published: . Volume 5, No. 6. Source pages: 12, 13, 14.
As the mental health profession continues the slide into medication as a primary form of treatment, a small group of family therapists in the Shreveport area work to light candles in the dark.
The group of counselors and family therapists at the Red River Institute is led by outspoken Director Tom Moore. Moore is a family therapist, educator and philosopher, who regularly takes aim at the growing trend to medicate people for their psychological problems, problems that he views originate in interpersonal and cultural contexts.
Moore, a Licensed Professional Counselor and a Licensed Marriage and Family Therapist with supervisor status, joins colleagues Howie Brownell, Dr. Katie Garcia, and Dr. Kelly Tyner at the Red River Institute (RRI) in Shreveport, Louisiana. Together they push for a more humanistic, holistic, and less chemical approach to life’s problems.
“It is ironic that in spite of the incredible spike of prescription drug used in our society in the last thirty years,” Moore explained to the Times, “our emotional and psychological ‘dis-ease’ as a society seems to be spiking as well.”
Medical journalist and Pulitzer Prize nominee Robert Whitaker’s 2010 book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America focuses on this disturbing fact. As psychiatry has gained ground, mental illness has skyrocketed.
“I think that the realization of this fact is causing consumers and providers of mental health services to take a fresh look at more traditional views of wellness that are rooted in physical, relational, and spiritual health,” Moore noted. “Chronic imbalances created by cultural and societal stressors erode our emotional and psychological resilience and create vulnerability to depression and anxiety. Since the beginning of time the only tried and true answer to this vulnerability seems to be a collaborative, supportive network of relationships–our ‘village.’” And he said, “The research is clearly showing us that relationships heal—not pills.”
Dr. Katie Garcia is Moore’s colleague at the Red River Institute and formerly the Clinical Director at the Center for Families in Shreveport. Dr. Garcia warns against the mechanic approach so common today. “A person’s mental health is quite unique from other forms of physical, bodily health,” she said. “There is a certain mystery and beauty to it. There are so many aspects to brain and mind that we do not, and cannot, understand.”
Those at RRI try to keep the faith; holding that much of modern malaise is not a problem that stems from, nor can be remedied by, biochemical adjustments. Rather they say, our problems emerge from a toxic disconnection from self, others, and the community. The place to promote the healing is not in a pill but in our relationships.
“According to family systems theory,” said Dr. Garcia, “people cannot be viewed in isolation. When we attempt to treat an individual’s diagnosis or ‘mind,’ we are completely discounting the entire context in which they live,” she said.
“The entire field of marriage and family therapy was originated by psychiatrists who were finding themselves continually frustrated at seeing patients’ symptoms improve in an isolated environment and then immediately relapsing once they were returned to their home environment.”
“Problems stem from difficult relationships,” Garcia said. “Not just problems such as infidelity or parent/child difficulties, but even drug abuse, depression, schizophrenia, eating disorders, anxiety disorders, and more–all can be understood through a systems framework by looking at the context in which the behaviors occur.”
“I also believe that problems can be resolved the quickest when these relationships can be discussed openly, with all parties involved, in the context of a therapeutic setting. If any of these are absent, the process can take longer,” she explained.
The group at RRI holds firm to this philosophy, speaking out frankly about what they offer and why it is important to the consumer on their artfully designed webpage, offering news, articles, commentary and resources for professionals. Moore also hosts a frank discussion on his blog, Perspectives for the Postmodern Healer, the philosophy captured by topics like “The Witchdoctor Speaks” and a “Healer’s Manifesto”
The Manifesto lays out affirmations for the family therapist: “I reject the molecular hypothesis as a sufficient summation of the human condition,” and “I practice a traditional ‘healing art’ that is rooted in and utilizes relationship and community.” And, “In my work, I seek to preserve the integrity of the whole person, the uniqueness of the individual, and the sacredness of the human being.”
Another of the Marriage and Family Therapists at the Institute is Howie Brownell. “… we are healers and not mental mechanics,” Brownell said. “We promote healing contexts and not ‘fix’ people like they were broken toasters or machines. We are human and have our unique approaches to the world,” he said. Brownell especially likes a quote from the movie Patch Adams: “’When you work with illnesses you win some you lose some. When you work with people you win every time.’”
Sky-rocketing use of antidepressants
The group is in good company when it comes to their concern about the overmedication of the consumer. One in ten people in the U.S. now take an antidepressant according to the Center for Disease Control. Antidepressants were the most common drug used by adults age 18 to 44. And, once taking the drugs, 60 percent of people continue taking them.
Why the dramatic increase? “The simple answer to that is money,” said Director Moore. Experts suggest that the global market may be $693 billion. “The wide range of problems that the pharmaceutical companies claim these drugs can treat reminds me of the old traveling medicine show peddlers in the mid-1800’s and has led to massive off-label prescribing …”.
“What the research is showing us, however, is that there is much more wishful thinking and sophisticated marketing behind these drugs that real science,” Moore said.
Moore’s views mesh well with scientists who are looking at the issues. Last fall, in a joint conference sponsored by Tulane and the Louisiana Psychological Association, a premier researcher in the area, Dr. Irving Kirsch, Associate Director of the Program for Placebo Studies at Harvard Medical, told the attendees, “The placebo response is about 75 percent of the drug response.” Kirsch’s work also shows that the non-placebo benefits of drugs often make little practical difference for the patient.
Some scientists are beginning to look at the big picture problems for tinkering with the neurotransmitters. In an article about the evolutionary importance of serotonin, “Primum non oncere: an evolutionary analysis of whether antidepressants do more harm than good,” (Frontiers in Psychology). Authors warned that serotonin is involved in many complex, interconnected adaptive processes, explained nutritional biochemist, Cass Nelson-Dooley, of Health First Consulting.
She explained that the authors see serotonin as an ancient system, having evolved one billion years ago and we share it with animals, plants, and fungi. “Serotonin is under tight homeostatic control in the brain, gut, and blood plasma,” she said. “The article shows that SSRI antidepressants affect every major system regulated by serotonin.” While antidepressants have a modest effect on depressive symptoms, there are many risks. The authors suggest that targeting the serotonin system with drug therapy results in a ‘push-back effect,’ to achieve homeostatic equilibrium, that ultimately makes the risks of the medication far outweigh the benefits.”
This relates to other research showing that while depression appears to lift faster, patients tend to relapse, and what should have been a short phase of depression becomes chronic.
“Pharmaceutical companies spend an exorbitant amount of money marketing and advertising,” said Dr. Garcia. “This approach has been tremendously successful with the general population. It is now impossible to watch a television show without seeing an ad for some drug for some mental illness, and if the current drugs you are using are not working, the ad will recommend adding an additional one. The underlying message is- this is what works, and if it is not working, get a stronger dose. I have seen countless clients who have been prescribed psychotropic medications who have seen absolutely no benefits, but refuse to question their efficacy.”
Does the new DSM help or hurt?
With the release of new DSM-5, some critics point to additional problems for consumers of mental health services. In a recent issue of Psychology Today, Allen Frances, M.D., listed a host of concerns, in “DSM5 in Distress.”
“New diagnoses in psychiatry are more dangerous than new drugs,” Frances wrote, “because they influence whether or not millions of people are placed on drugs– often by primary care doctors after brief visits.” Temper tantrums become Disruptive Mood Dysregulation Disorder, simple everyday worries become Generalized Anxiety Disorder, and normal grief is now Major Depressive Disorder, “… thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substitution pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and acceptance of the limitations of life,” wrote Frances.
The theme blends well with the RRI’s concerns. “The stated intent of the manual,” said Moore, “is to provide an atheoretical taxonomy of symptoms that allows health professionals of different disciplines to communicate effectively with one another about their patients or clients. Instead,” he said, “the DSM has been used to classify and label people rather than symptoms. Mental health professionals who practice psychotherapy or family therapy understand how anti-therapeutic this labeling can be, especially for children.”
Dr. Kelly Tyner, Marriage and Family Therapist at the Institute and at the Veteran’s Hospital in Shreveport, agrees.. “I think the original intent of the DSM was to assist mental health professionals in communicating efficiently with one another about what individuals are struggling with. Instead what we have is a method for professionals to explain particular behaviors.”
She views this as limiting rather than helping. “I can't count the number of times I have heard mental health professionals say that they don't work with a particular group of individuals simply based on their diagnosis.”
“The overreach is tremendous,” agreed colleague Garcia, “with such little research to verify its credibility. The language has even evolved, once being referred to as a guide, and now seeming to imply the content as fact. The problem is, these disorders and diagnoses cannot be objectively measured, as diabetes or cancer or high blood pressure can.”
Brownell, thinks it may take a whole new way of making sense of our problems. “… it doesn't help us resolve the problems associated with this ‘thing’ that we call human experience,” he said. “I think that instead of trying to objectify and validate what we do we as practitioners, we should accept that we are wordsmiths and we practice an art form that encapsulates the absurdity that is part of our humanness and must be embraced as such, and not medicalized. “
“We have moved to an isolative type of society,” said Dr. Tyner. “With the advent of the television in main stream America, we have developed more and more ways of isolating ourselves from one another and mentally checking out from what's going on around us. Simply look around you and note the number of people who are interacting with an electronic device instead of the people around them. I'm actually in a conference typing this on my phone right now!! The idea of the village that Tom brings up is an exceptionally important idea. It evokes ideas of interaction and connection and these are things that are vital to emotional health.”
One of the core beliefs for those at the RRI is the value of the relationship, consistent with the newest findings from outcomes researcher and psychologist, Dr. Jeb Brown of the Center for Clinical Informatics. Brown, using new linear modles and very large data bases, has found what is often suspected. “Across the board it is the therapist that explains the outcomes,” Brown said to the Times previously, “not age, not experience, not credentials, or the type of therapy.” This even includes whether medication is helpful. “Therapist effects,” said Brown, “this is what is driving things. It resides with the therapist.”
Efforts to hold both humanistic and scientific strains of the rope together
Therapists at the Red River Institute see their own efforts as connected to their colleagues, their interns, and the larger community. The group stays active and in practice and educational efforts, including conferences, training, their Director’s blog, and (http://www.redriverinstitute.org/) website.
“Our Spring Conference in Shreveport is a celebration of the art of talk therapy,” said Moore, “always accompanied by a bold critique of the mental health profession. We are developing our new website into a hub of reliable information for the independent nonmedical mental health provider,” he said. “We also use our website to keep professionals informed about how they can take political action to prevent the further ‘medicalization’ of the mental health profession through legislation.”
The group also sees the issue within the professional community to be an area for collaboration. “Our mental health community is constantly attempting to answer questions and find treatments when problems arise,” said Dr. Garcia, “and all professions within mental health should be given much credit for their true desire to explain a part of our body that is often unexplainable. I think what is important is for us to be clear and transparent about what we, as a mental health field, know and what we do not know–what we hope to know, and what we can never know,” she said.
“Mental health problems will never have a ‘quick fix,’” she said. “We need to place more value on spending time with our clients in a therapeutic setting and helping them find their own solutions for life’s difficulties and problems.
Brownell points to problems with the culture. “I also believe as Edwin Friedman stated in his book, "A Failure of Nerve" that our culture has anxiety that is related to a collective loss of nerve. It represents a regression or ‘throw back’ to earlier points in world history where we have seen a creativity gridlock, which essentially results in reacting rather than ‘proacting.’ As professionals, we need to, as Friedman offers, rise above the morass that we get caught in so that we're not stuck with our culture in the problematic situations.
And for the family therapists at RRI, it may begin with the basics. In the Witchdoctor blog, Moore reminds his students and readers that all ancient healing disciplines teach that the ‘right action’ flows only from the ‘right motive.’
And, for the professional healer, the motive is always compassion.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.