Perhaps the most crushing thing about living with severe mental illness is the social isolation. Before things became serious, I had a social network. Out of the many numerous benefits, I could bounce ideas off friends and colleagues. I could get feedback on anything I wrote.
I fought hard to keep my social network in place. But once mental illness takes hold, friends disappear quickly. I am still shocked at just how easily I was forgotten by most of my friends. I kind of get it. Mental illness is a scary thing to be around. I couldn’t communicate how much scarier it was for me.
So, while I find myself in the extraordinarily lucky position of finding a treatment that is slowly reducing my anxiety symptoms, I also find myself with very few friends to speak of. The situation is improving – but these things take time.
The limited ability to attain feedback is not exactly at the top of my list of “problems of not having friends” but in the context of Substack, it is relevant!
It also doesn’t help that I’ve fallen into strange psychological irrationalities. It seems that the riskier the article, the greater my fear that it isn’t very good, the less I want to reach out for feedback. So, I release it to the public instead un-feedbacked. This makes no sense whatsoever.
The most prominent feeling I’ve felt after publishing the two Psyverse #1 articles is embarrassment. My previous guest posts were all serious critical analyses, and suddenly, here I am launching into moth-people with no context whatsoever. From the little feedback I’ve had so far, it seems most people are confused. But without knowing more detail, I am not sure how to fix it for future posts.
While I feel a bit vulnerable asking you so openly for feedback, I feel like this is the logical thing to do. I haven’t really seen other writers on Substack publicly ask for feedback (other than for topic suggestions). But I don’t have the friends or colleagues to provide feedback for this article about asking for feedback. I am stuck in a lack of feedback loop.
So, if there are readers out there who would be so kind as to tell me what they thought of the Psyverse #1 articles, I would be grateful. Rather than public comments, I’d appreciate a direct message, or email (see here).
To help, I’ve put the main message I wanted to convey in Psyverse #1 in this footnote,1 some of the questions I have in this footnote,2 and some of the reasons why I wanted to start the psychiatric multiverse in the first place in this footnote.3
Thank you to those who will take the time to write feedback on the Psyverse #1 pair of articles – it is much appreciated!
The following is a simplification.
In physics we have a model for how very small things, like atoms, interact (Quantum Mechanics). We also have a model for how the very large things, like planets, interact (General Relativity). At the moment, these models are incompatible with each other, we cannot draw lines of logic from the microscale superpositional world of atoms to the macroscale cosmological curvature of spacetime. But we do know in all probability that these lines of logic exist. Physics as a subject would fall apart otherwise. This is the coveted “theory of everything” physicists are working hard to outline.
In psychiatry, there is a model for how very small systems interact (Biomedical model. i.e. genes, chemicals and neurons). There is also a model for how very large systems interact (Psychosocial model i.e. people with other people). At the moment, these models are incompatible with each other. Lines of logic cannot currently be drawn from the microscale neuronal interactions in a brain to the macroscale psychological interactions in a society. In all probability, these lines of logic exist. Psychiatry, psychology and neuroscience as subjects would fall apart otherwise. This is the coveted “biopsychosocial model” psychiatrists, neuroscientists and psychologists are working hard to outline.
The difference between physics and psychiatry is there are no quantum physicists arguing vociferously, with little evidence, that every scale of physics is described entirely by quantum mechanics, nor are there cosmological physicists arguing, with little evidence, that every scale of physics can be described through the curvature of spacetime. There are no “factions” or a “centre ground” of physics. Physicists see it as a problem of scale, not ideology.*
While I believe the degree of polarisation is much less prominent than the public might think, in psychiatry there are factions, and there is a centre ground (arguably, the psychosocial end of the spectrum extends to greater extremes - the antipsychiatry movement - than the biological end). Polarisation, nevertheless, exists. There are psychiatrists and patients arguing vociferously that every scale of psychiatry should be described psychosocially, going as far as to say that the biological model of psychiatry should be abandoned. While I’ve seen defences of the biological model, I’ve not been able to find an argument that the psychosocial model should be abandoned. Still, there is no doubt that there are plenty of stories of patients who have suffered from overprescription of psychiatric medications.
As a physicist I find this kind of polarisation bizarre, and as a patient I find it depressing. Though I understand how this kind of polarisation can occur.
I know I have a disease, and I know I needed psychiatric medication for my disease. You could have placed me in a tropical paradise, in the best possible environment with all my needs accounted for, and I would still be in severe suffering. The cause of my specific mental affliction was almost entirely biochemical.
This was not the view of any of the psychiatrists and psychotherapists I encountered in my treatment. All of them seemingly placed my disease state closer to the psychosocial end of the spectrum, despite my serotonin syndrome (and the dramatic mental dysfunction immediately afterwards) being a rare strong and clear indicator of a predominantly biological cause. Even after 300 hours of counselling of multiple modalities, some psychiatrists were pushing for yet more counselling and were hesitant to prescribe medication (attitudes in the UK might differ from the US).
There are some psychiatrists who would argue that cases like mine don’t exist. For example, Mark Horowitz talking to Alex Curmi on the Thinking Minds Podcast as described by Thomas Reilly:
One aspect that concerned me though, was Mark’s reluctance to acknowledge any biological aspect to depression, or the utility of antidepressants. Alex asks Mark whether he recognises that some cases of depression do have a biological component, giving examples of severely unwell patients who may struggle to eat, or become slowed. Mark put the chance of finding biological causes of depression as very, very slim. Instead, he sees depression as ‘normal brains responding to events in life’.
So, in my head I wondered, if I needed to work with psychiatrists like Mark, how would I do it? Mark’s position is very different to mine, and most psychiatrists. If Mark and I were to have a conversation restricted to the etiology of mental illness, I think things would probably get heated very quickly.
I was struck while attending storytelling events like The Moth and Spark Stories how quickly low bandwidth, yet deep emotional connections could form. Five minutes was all it took. From personal experience, I also knew that these types of connections with people (formed over a longer period while doing activities like improv classes) helped me feel less antagonistic when ideological discussions occurred.
Therefore, for Psyverse #1, I was hypothesising that if storytelling events became part and parcel of psychiatrists’ everyday life, the animosity that can be found between ideological factions within psychiatry might be more easily overcome. Perhaps psychiatrists might more easily be open to discussion, and more willing to work in teams.
Thus getting closer to the future of psychiatry outlined by Robert Pies in his discussion with Awais Aftab (titled: The battle for the soul of psychiatry):
So my chief hope for “the future of psychiatry” is that it recover its pluralistic “core”—what I earlier described as the AJE tradition. I say “recover” because, as I noted earlier, I believe that psychiatry’s “solid center” is besieged by market-driven forces that would like to reduce us to “writing scripts” and “turfing” psychosocial interventions to less costly non-physicians. We need to push back hard against those trends! At the same time, I would like to see psychiatry achieve much better integration with neurology and general medicine, in what has been called “collaborative care.” I also think psychiatry has to do a much better job of “public outreach,” whereby we go out into the community in a proactive way, so that the general public has a better understanding of who we are and what we do. We can’t afford to let antipsychiatry define us in the public mind. The stakes for our profession and the well-being of our patients are far too high.
*Note: Seeing general relativity vs quantum mechanics as simply a problem of scale is an oversimplification (As an ex-experimental electron microscopist, a deeper discussion is well above my pay grade!). And there is debate about how far one theory extends into the other. Importantly, I don’t believe there are physicists pooh-poohing the evidence of each theory.
If you found the Psyverse #1 articles confusing, what was confusing about them? What did you like, not like? Would it be better if I set out the problem first and then went into talking about moths? If you wanted to combine the serious point made in Footnote 1 with the joy of science and finding things out outlined in Footnote 3, how would you do it?
As kids, my twin brother and I created entire shared universes together. With a set of simple toys, we imagined vivid universes and characters. My imagination provided me joy.
During the worst parts of my mental illness, however, my imagination was turned against me. Instead of providing relief, my severe anxiety twisted my imagination into producing living nightmares I could not escape from.
Not much of my past self has survived the filter of mental illness, but fortunately, the joy of imagination has. It has slowly returned. Writing Psyverse articles has been the first time in a very long time where I have felt good using my imagination. It is a joy I want to share.
Instead of Psyverses, I could just write plainly about my experience of mental illness and the psychiatric system, but other people do it much better than I ever could (e.g. Susan Mahler, Leon MacFayden, Skye Sclera, etc.). And the more I write about my past experiences of mental illness, the more miserable I become in the present. I am trying to combine the joy of imagination, with the problems psychiatry faces. And I am struggling to find the right formula to achieve this. So, I could use your help.
Alex, I would be happy to offer my thoughts (perhaps they will even be helpful). I think you have something incredibly unique to offer the discussion, and for me it boils down to this: "as a physicist I find this kind of polarisation bizarre". You are able to think about things in a way that is unlike almost anything currently available in the mainstream, and this is a double-edged sword. Firstly, to the good: any unique perspective is valuable. Using your own way of thinking as a physicist, you can see the strange polarisation of the mental health paradigm, distill it down using your own models, and offer something back to the discourse.
The challenging part (if you can call it that) is that engaging with your work requires mental effort, it requires people (probably people familiar with the psychiatry paradigm) to envision an entirely new way of thinking. As you've established, much of the field is interested in defending their corners rather than expanding their thinking. What you write is not following a trend or playing to the crowd, and for this reason alone it is valuable. I hope it is widely read and debated in time, but it will receive less fanfare simply because it's not an easy read. Things worth engaging with usually are not.
I like the framing of the Psyverse, it's an creative play on the cliche of "just imagine if the world was XYZ", the challenge is how to weave together our world and the psyverse to make your central point. If I can offer a suggestion, perhaps the answer will present itself if you write with this as the core to everything: "I wonder what the world would look like if everyone had that one percent emotional connection with each other, to be one percent Moth." What would psychiatry look like?
I don’t know, Alex. I think your analogy is interesting. I started my blog after a minor episode when I tried to taper off my meds too quickly, and I felt a real sense of despair about living without them. I’m not anti medication or anti psychiatry (though I’ve never been hospitalised) or spent any real time as a mental health service user. I thought that psychiatrists would be open to talking with me, but any attempts to open conversations have been met with condescension at best and stonewalling and a surprising amount of callousness in between. Despite writing what I hope is a varied and unbiased blog with the aim of destigmatising psychotic symptoms, which seems like a worthwhile pursuit to me, I have been really disappointed by the response from professionals in particular who have positioned themselves as far as they can possibly get from it. This platform has done me more harm than good so far, which I was not expecting at all, since I’m not a needy person. However, most people with a mental illness are, by definition, in need of kindness, and a cooperative approach, not an authoritarian brick wall, so it’s a good job that I am well enough to take the cold shoulder treatment. Apart from Skye (above), I’m shocked by the very real absence of it in terms of moral support. A lot of my posts have a very high number of readers who never breathe a word. I know it’s the stigma of being seen reading my blog, but still, it’s unnerving talking into a silent void. In that sense, the analogy with physics holds, as it seems that more individuals than I thought from the profession of psychiatry want to proceed without changing anything about their current MO. It’s discouraging.