An Interview with Will Hall:

Today I’m interviewing Will Hall.  Will is a survivor of a schizophrenia diagnosis and a leading organizer in the psychiatric survivor movement.  He works with individuals, couples, families and groups as a counselor and facilitator; has taught and consulted on mental health, trauma, psychosis, medications, domestic violence, conflict resolution, and organizational development in more than thirty countries; and been widely featured in the media for his advocacy efforts around mental health care.  He is the host of Madness Radio and the author of The Harm Reduction Guide to Coming off Psychiatric Dugs.  His book Outside Mental Health: Voices and Visions of Madness was a semifinalist for the Publishers Weekly BookLife Prize for nonfiction.  Will is also a PhD candidate at Maastricht University’s School for Mental Health and Neuroscience with a research focus on psychiatric medications and alternatives.  You can learn more about Will at www.willhall.net.

We talk here about power in therapy, psychiatric diagnosis as problematic, naming ethical and professional dilemmas, working outside of the mainstream mental health system, understanding emotional distress contextually, tragedy as potentially transformative, the psychiatric survivor movement, and preventing mental health crises by creating healthy communities. 

The following resources were mentioned in the interview:

• • Will Hall | Outside Mental Health: Voices and Visions of Madness | Madness Radio | Harm Reduction Guide to Coming Off Psychiatric Drugs
  • Mad in America
  • International Society for Psychological and Social Approaches to Psychosis (ISPS)
  • Hearing Voices Network
  • Open Dialogue
  • Soteria Houses
  • Trauma and Recovery by Judith Herman
  • Man’s Search for Meaning by Victor Frankl
  • The Divided Self by R.D. Laing

Transcript

Ryan:  Well, welcome Will, good to see you.

Will:  Thank you, Ryan.  It’s great to be here.  Thanks for the invitation.

Ryan:  You bet.  So I thought I’d start by asking you to tell us who you are and how you spend your time.

Will:  Oh, who am I and how I spend my time!  Gosh, that’s a really big question.  “Who am I?”  That’s an existential, philosophical, spiritual quest I think a lot of us have been on for our whole lives.  But in this context, I am a therapist and I work with individuals and families especially around experiences that get diagnosed as bipolar, schizophrenia, and psychosis.  I’m not anti-medication.  I have a harm reduction perspective on medication.  But I find that the best way to help people is from outside of the mental health industry framing, which is why I said “experiences that get diagnosed as,” because actually what the experiences are is a very interesting, complicated question.  And I find it most helpful to take a step back from the traditional approach.

I got interested in becoming a therapist because of my work with the psychiatric survivor’s movement. I, myself was diagnosed.  I was told that I have a kind of schizophrenia called schizoaffective disorder.  I was in hospitals and mental health residences.  I was on a disability check for many years.  And what I found helped me was community and connection and friendship.  And so that led to doing presentations and talks and then consulting and training.  And then I went and got a degree in a kind of Jungian counseling called Process Work, which I think has a very innovative approach to psychiatric diagnosis and psychosis and different experiences that get labeled bipolar and schizophrenia.

I’m currently also now a PhD candidate at Maastricht University in psychiatric epidemiology, doing my work on psychiatric medications.  We did a big survey on antipsychotic withdrawal.  And I do a lot of community development work around mental health advocacy.  So I have a podcast.  I do Madness Radio.  I’ve been involved with a couple of radio stations.  I’m involved with Hearing Voices Network.  I do writing on Mad in America.  I’m involved with different creative advocacy community building projects.  Like, for example, we’re doing a summer camp this summer in Northern California for mad people, people identified as psychiatric survivors, just to build community and come together.  And I’ve been doing work broadly described as the mad movement for, I guess, fifteen to twenty years now.

Ryan:  You’ve said so much, and I feel like we could take this in so many different directions.  So you mentioned that you like to work outside of the traditional mental health system.  You also have a podcast named Madness Radio.  And you have a book titled Outside Mental Health.  So I’m wondering if you could talk about the choice of those titles, Madness Radio and Outside Mental Health.

Will:  Yeah.  I mean, there’s a lot of different ways to answer that question, and maybe I’ll just answer it through my experience, my story.  So I was in my twenties, and I had been suffering a lot with what I called depression.  But it was a lot more than that.  It was a lot of different things going on, and it reached a point – I had lost my job.  I was struggling financially.  I was spiraling down.  There were a lot of different things that went into that experience.  But basically, a crisis built, and I was really in pretty severe altered states.  I was convinced that people around me were trying to hurt me.  I was afraid of my roommates so much that I would leave through the window of the apartment.  I was wandering the streets of San Francisco in the middle of the night.  I would see people and then run away from them because I thought that they were sending me messages.  I had very aggressive voices.

And so I was going through something that would be called psychosis.  I was having a psychotic experience.  And my therapist at the time said, well, go and get a medication adjustment.  I went to the clinic.  I ended up in the psychiatric hospital.  And there’s something about getting recognized for the depth of your suffering.  There’s something about being told “okay, look, your suffering is severe enough that these authority figures, these experts, these medical professionals are going to say, ‘yes, we’re going to give you a medication, or, yes, we’re going to admit you to a hospital.’”  And there was something very validating and very encouraging and hopeful about that.

So I was thinking, “okay, wow.  There’s this thing that I’ve had going on.  I’ve been living with a headache, or I’ve been living with an infection, and it’s been affecting my thinking.  My intelligence has gone down because I’ve had this chronic infection, and so now I’m going to get some antibiotics, I’m going to fix the infection.  And then I’m going to be able to perform and live at the level of happiness and clarity and energy and trust and engagement that I haven’t been because I’ve been impaired.”  It’s like I had been neglected.  I was an untreated ill person.  And I really went along with this.  This was the framework.  I was completely all in in the hospital.

Ryan:  It sounds like it actually instilled some hope early on.

Will:  Absolutely.  There was that.  There was a sense of, “wow, there’s a solution.  There’s an explanation for my suffering.  There’s a reason why I’ve been losing my jobs.  There’s a reason why I keep getting isolated.  There’s a reason I can’t sustain relationships.  There’s a reason why I have so many financial problems.  There’s a reason why I keep sabotaging myself in my career, I find it hard to focus, I have such anxiety and despair and depression.  There’s a reason for it, and I’m just going to get it fixed.”  That’s the promise.

So I went all in on that, and I’d try one medication.  I’d try another medication.  I’d try another medication.  And I wasn’t getting better.  I was finally discharged from the hospital because the insurance ran out.  And so I went through the system and had tried different medications, including antipsychotics.  And it just wasn’t something that I experienced as helpful for me.  And I also came in with a certain amount of skepticism.  For a long time – I grew up and in my life, I’m the kind of person who questions authority and asks critical questions.  And I think for myself, and I do my own research, and I look at things from different perspectives.

And a lot of things started to fall away that the psychiatric system had told me.  And then a different perspective came in about what actually could help me.  So for example, when I was in a mental health residence, everyone was on medication.  I was in a residence called Westside Lodge at Page near Market in San Francisco.  Everyone was on medications.  And what I saw was that some people who came in and they would not make eye contact with you, they would not talk to you.  These are new patients that came in.  They were staying away.  They weren’t talking.  They would start medications and they would come out their shell.  They would start talking, they would start connecting with people.  And there was clearly some kind of benefit for this person.

Other people – there’s a guy, I remember his name was [redacted].  He was seventeen years old.  He came into the program – maybe he was eighteen- and he came into the program.  We watched him gain about forty-five pounds from his medication.  And he was not getting better.  He was not becoming more engaged.  He was not getting more connected with people.  He was clearly in distress.  So, a lot of the message about medications are helpful for everyone wasn’t my experience, and it wasn’t what I was observing.

I also started to question: “why was I put in restraints?  Why was I put in an isolation cell?  Why was I threatened?  Why was I held against my will to begin with?”  These things were told [to me], that I needed these things.  But I realized, “wait a second, I went into the system, into the hospital with a lot of problems.  Now I have trauma from the force that was used against me.”  So I started to discover that there’s this huge history of psychiatric patients questioning the paradigm of mental health treatment from a lot of different perspectives, including dissident scientists who were questioning a lot of the scientific, or so-called scientific claims.  I was told that, “well, there’s a predisposition, there’s a genetic predisposition for schizophrenia.  That’s why you have schizophrenia.”

And they were very interested in that, in my family history, and establishing that, yes, there is this genetic – I was never asked, “is there any history of trauma for you or your family?”  My father is a veteran of the Korean War.  He was tortured.  He was in prison.  He was emotionally, physically, and sexually abused as a child.  My mother also was … none of this was ever discussed.  So I started to make a lot of connections that what I was told in the system didn’t really hold up.  And the treatments that were offered didn’t really help me, so I need a different point of view on this.  I was able to start understanding myself as a trauma survivor.

One of the books that I read was Judith Herman’s book Trauma and Recovery, which is an extraordinary book that I really recommend everyone read.  I read that book like a menu.  I went through and I underlined, and I starred, and I circled, except for the chapter on child abuse.  I was so shaken and overwhelmed because I was really discovering myself in a way that I had never been offered when I was in the psychiatric system where 24/7 people are supposed to be helping me with my experience.

So through developing a trauma perspective, I recognized that the existing paradigm, the standard of care of psychiatric treatment doesn’t work for everybody.  In fact, that works for very few people.  It’s based on very shaky scientific claims.  There are enormous numbers of people that are being traumatized by the system.  And there’s a huge global movement of psychiatrics survivors and our allies working to change.  So when I tried to go back to graduate school and I tried to get my life together, I was really trying to leave my history behind, and that fell apart.  I flunked out of graduate school.  I was homeless again.  I went back into a mental health residence.

And then when I came out of that residence, something shifted in me.  I realized that instead of running away from this experience, I had to go deeper into it.  I had to understand, I had to answer some of these questions.  And the way I was going to do it was, instead of meeting people and not talking about my psychiatric history, I was going to start bringing my psychiatric history forward and then meet other people who also had psychiatric histories.  Then maybe part of what I was going through was stigma and isolation, because this big part of who I was wasn’t accepted by society.  It wasn’t accepted by me.

And this is a turning point.  This is the turnaround moment is that I started to work – we founded a group together.  I started to work in a community of other psychiatric survivors.  And through what I’ve seen and also what the research says, that the existing standards of medication, forced hospitalization, diagnosis, that this actually isn’t a solution for people’s mental health problems.  Actually, that it’s, in many cases, making the situation much, much worse.

What I was told is that, “well, yeah, there’s some side effects for these drugs, but it’s so worth it because the untreated illness is so much worse.”  Actually, medications can be much worse than the condition that they’re originally prescribed for.  The use of force and coercion and really kidnapping and assault in the psychiatric hospital system was told to me as, “oh, well, it’s necessary.  It’s better than letting people die by suicide.  Or it’s required because people are out of touch with reality.”  Actually, the research doesn’t support that.

Ryan:  Or, for your own safety, to protect you against yourself.

Will:  Exactly.  The research doesn’t support that.  And we can go more deeply into that.  So to answer your question, when I discovered in myself a calling, because I think that’s really what it is, I think that working – let’s call it the healer role, or the helper role, finding a calling as an artist.  I mean, you really have to – something deep inside of you has to bring you to that.  You can’t just do it because you think it’s going to give you a good income and it’s going to be a nice lifestyle.  You have to really have a calling for it.  So when I discovered that I had this calling in the support groups that I was in, I asked myself, what’s the best way to help people?  And it wasn’t inside the mental health system, it was outside the mental health system.

And there are a number of very interesting innovations that are coming from outside.  One that your listeners should know about is the Soteria houses.  Another one is Open Dialogue, and the other is the Hearing Voices Network.  And all of these have been pushed by the psychiatric survivor movement as outside options that we should learn from and we should start to move in the direction of.

And so now the mental health system and psychiatric public policy is a hugely contested field.  There’s no consensus on what’s the best way to manage people’s mental health in large populations the way that there is a consensus on what’s the best way to manage a watershed with water management district and dams and irrigation and aquifers and all these different things in terms of that kind of science.  Certain areas of science, there’s much more of a consensus.  Other areas of science – and we can, of course, get into environmentalism and that whole critique as well.

But the point is that the science behind psychiatry and mental health has always, from the very beginning, been up for grabs.  There’s been tremendous controversies, there’s been tremendous disagreement.  And the existing public policy choices around mental health practice are not based on best science.  They’re based on dominant politics.  What political faction has risen to the top.  In the U.S., It’s the pharmaceutical industry, the hospital industry, the private insurance industry, the mercantile cartels of psychiatrists and hospitals and the entire industry around mental health, which is allowed to dominate despite the science, because we live in a for-profit context.  And so the regulatory apparatus that started to be built up in the 1960’s and 1970’s, whether it’s the Food and Drug Administration, or it’s the National Institute of Mental Health, or the Department of Health and Human Services, all the different agencies at the federal level that should be providing oversight and regulating based on best practices and people’s basic needs, those have fundamentally been captured by the industries, that we have a systematic corruption of science and medicine in the United States.

And so my work is to do something different in my private practice, to do something different in my work as a PhD student, to do something different in the community.  And also to raise the alarm about this, that we are really at a dead end with mental healthcare and healthcare in general.  We need a completely different understanding.  We need a community development model.  We need to be empowering communities, not providing services or products for communities.  The logic of bureaucratic expansion or profiteering does not serve human well-being.  And we need to do it in a way that really honors the unique individual process that each of us goes through.

Fundamentally, a mental health crisis is about suffering.  And how you deal with suffering is a deeply personal, philosophical, spiritual, religious existential question.  So the idea that we have a technical, scientific medical class that’s going to step in and tell us what is the best way to live, or the best way to respond to suffering and to create meaning in our lives is completely backwards.  It’s just an encroachment or a colonization of a very important human realm that we have to revitalize.

Ryan:  There’s an attempt to universalize it.

Will:  Yeah.  And to dominate – one perspective to dominate other voices.  So that’s why I see my work coming from outside the mental health system.  And that’s why I use words like “madness.”  And I use phrases like “extreme states,” because I want to step away from the assumptions and I want to really grapple with these experiences directly on their own terms.  And people ask me, “Will, what kind of a mental health system would you like to see?  What reforms would you like to see?”  And my answer is, “I would like to abolish the mental health system.”

Because when you ask someone “well, define mental health,” people talk about anxiety, they talk about connection with other people.  They talk about energy levels.  They talk about enthusiasm.  They talk about the sense of peace and contentment and happiness and a sense of thriving, and a sense of being free of fear.  And now you’re having a conversation about life.  There are no boundaries between mental health and the rest of society.  And so if we want to have healthy mental health, we have to have healthy communities.  We have to have a healthy society.

As a therapist, if someone says to me – often, the people that I work with, I’ll say, “well, why are you here for therapy?”  And someone says, “well, I want someone to listen to me, and I want to feel supported.”  My job isn’t then to be the person who listens to them and give them support.  I mean, that’s part of my job.  But a big part of my job is asking, “why don’t you have people listening to you and supporting you in your life?  What are the obstacles?”  And then in that process, many people can make big changes and they make new directions in their life, and they are able to get those things.  But people come up against this wall.  Eventually, the conversation, “why don’t you have friends and why do you have stress and why don’t you have people to listen to you and why don’t you have connection and support” comes up against the wall of, well, we live in a capitalist, hyper-individualist, isolated society.

I think one of the biggest solutions to mental health crisis in the United States would be if people had more time to spend listening to each other and taking care of, of each other, instead of working forty, fifty, sixty hours a week.  If we had permission and support to build communities of care, then that is going to help us not just respond to mental health crisis but prevent mental health crisis.  And there’s many problems with the twelve-step Alcoholics Anonymous (AA) approach.  But I think there’s a tremendous success.  And it’s really a model, a self-help, community empowerment, voluntary-based association where people provide mutual aid for each other.

Churches have been doing it historically.  Churches, of course, have huge problems.  But there’s something in those models that’s extremely instructive.  How do we create a society that is nurturing and supportive and provides meaning and connection and listening and caring so that we’re going to be able to respond to mental health crises before they develop?  And then when someone does get into an extreme situation, we’re going to have the space and resources and time to care for them, to protect them, to yes, create safety for them.  But without the heavy handed, industrial, bureaucratic, prison-like response that we have with the mental health system today.

The cornerstone of my work, again, is coming back to that individual experience.  Sometimes people just need one session of encouragement.  “Hey, you seem to have a belief that you’re not a good person.  Have you thought about that maybe you are a good person?”  And to set something like that into motion, may be all that the person needs.  Other people are crushed and limited and trapped by forces way beyond their control.  It could be generations of ancestral trauma around racism.  It could be extreme poverty.  It could be long lineages of sexual abuse that have been hidden and covered up in their family.

So I always start with: the individual has their own experience that needs to be respected.  But if I don’t see the social, political, economic context, if I don’t have that capacity to sit with someone and say, “yeah, we’re up against a very hurtful, isolated society.  And a lot of what you’re going through, it sounds to me is really connected to this larger social system that we’re in.”  If I’m not willing to acknowledge that, then I just become someone who’s squeezing people into fitting into the system.  I’m helping the conveyor belt, and there are some widgets that are slightly broken, and I’m just fixing the widget to get it back on the conveyor belt.

And that’s fundamentally, I think, what the role of therapists and psychiatry has been, has been to adapt the individual to the society.  But my perspective would be that society is not something that we need to adapt to.  The society is something we need to transform.  The society is actually a crazy making society.  And not to adapt to it, but to challenge it and question it.

I work with a lot with family members, and they recognize their son or daughter or whoever it is is having a crisis, and they need resources.  They need a place for the person to go.  They need a break.  They need funds, they need resources.  The society doesn’t provide that.  And so I’m not going to cover that over in a therapy session, then make it about them: “why can’t you do this?”  No.  The society, the larger political, economic – and what they can do is they can become activists.  They can become advocates.  Instead of being disempowered by their oppression, they can fight back against their oppression.  And that’s where the connection between the individual therapy and the mad movement and the larger efforts to change society, I think, are bridged – when people realize that their personal distress is actually tied to oppression in society.  And then they can start to work with some of that distress by channeling it into something as simple as telling their story, speaking out, or helping other people, being someone who’s of service.

And this is something that Judith Herman talks about in her book, is that one of the key pieces of healing of trauma is empowerment, and then turning around and being able to become an advocate, becoming an activist, becoming someone who’s fighting for change in the society.  The word “trauma” has really become a much more medical, biological term these days.  Even with very sophisticated somatic body-oriented approaches to trauma, you’re still dealing with, in a lot of the ways, a mechanistic model of what is broken down in this machine.

Well, actually, the origins of the understanding of trauma in society came out of the protest movement against the U.S. War in Vietnam.  It came out in the women’s movement, protesting and raising the alarm around incest, rape, child abuse, and the mistreatment of women in society.  And the activists, the feminist and anti-war activists, who were speaking out about trauma, who created the context for PTSD, which was not a recognized thing.  That’s a relative late comer in the whole list of psychiatric diagnoses, that when they were pushing for that awareness, they weren’t just saying, “let’s fix people who are broken with good treatments.”  They were saying “let’s prevent breaking them in the first place.  Let’s create a society that doesn’t have war and patriarchy and rape and rape culture,” that they were actually calling for – and then in the institutionalization and the kind of co-optation and the mainstreaming of those movements, we get one part recognition of trauma, very sophisticated treatments, but we lose the other part, which is the critique of the society.

And that’s why I think the mad movement is so important.  People really need to look at the history of the psychiatric survivor movement, which came out of the gay liberation movement.  It came out of the civil rights and black power movement.  It came out of the women’s movement.  Gay women were often the leaders of the psychiatric survivor movement.  There were connections being made with psychiatric policing and policing in the prison system and the criminal justice system.  There was a connection being made between the profiteering of the pharmaceutical industry and the larger issues of privatized healthcare and capitalism in general.  So really, at its roots, the perspective of mad people has always been a challenge to the status quo of society, in general.

And I’m very influenced by the work of R.D. Laing and the way in which we need to recognize that it’s our society that’s crazy, that society is crazy.  The question shouldn’t be “why does someone break down?”  The question maybe should be “why are people putting up with this?  Why do people get along with the society?”  And it’s complicated.  I mean, there’s obviously lots of different individual experiences.  And even before capitalism, clearly, we have madness.  And every society, it seems, has faced individuals who, for whatever reason, go into these isolated, separating, disturbing, dangerous, extreme states.  And some of them don’t come back.  But some of those people are recognized as shamans.  Some of those people are recognized as healers.  Some of those are initiatory crises.

So even as we recognize that society needs to change, I think we also need to acknowledge that we’re dealing with a fundamental human mystery, that madness is not something that we’re just going to be able to unlock with the latest solution.  Even trauma, there are people that I work with where I feel like a trauma framework isn’t necessarily helpful for them.  And the innovative approaches that I mentioned – The Hearing Voices movement, Soteria houses, Open Dialogue – frequently, there are people that those approaches don’t know how to deal with.

So I try and keep an individual perspective and listening to the person’s individual story, but also a certain humility.  You know, it’s not like someone’s going to come in and I’m going to give them my treatment recipe, and I know that it’s going to – I’m not selling the latest magic pill.  I think that’s a fundamentally broken, flawed way of understanding that we’re going to solve the puzzle of madness.  No, we have to have an honest response and a caring response and a humble response.  That’s what I think is needed.

Ryan:  I’m so interested in this piece that you just talked about, about extreme states also having the potential to be very meaningful, very generative, very creative, fulfilling an important role in our community and our society.  And I want to hear you talk more about that, because it seems like all of that gets missed when we’re just pathologizing these experiences as problematic or dangerous or in need of medication or hospitalization, right?

Will:  I think of it as a doorway, that one doorway is the possibility of seeing your experience as transformative.  And another doorway is seeing your experience as just something you just want to control and get rid of.  And who wants to be depressed?  Who wants to be addicted?  I mean, these are devastating experiences.  So it’s not my job to tell a person which is the right doorway but is it my job to show them that there are multiple doorways.

The mental health system says there’s only one doorway.  You’re broken and you need to be fixed.  That’s what it says.  And some people do find that that approach is helpful.  Again, that’s why I said that I’m not anti-medication or pro-medication.  I have a harm reduction approach.  It wouldn’t be client-centered for me to tell people what the right way is.  But I do want to say, “well, there’s these different doors maybe you want to explore.”  And then the person themselves will decide what’s meaningful for them.

Ryan:  Your role is to give them information so that they can have choices.

Will:  Give them information, and also be there with them while they’re asking the questions.  And to be a listening space.  And listening is a very interesting thing, because often we hear ourselves through another person.  We are fundamentally dialogue beings.  And you can just talk to someone, and someone can just sit there and listen.  And then you can be clearer about what you think about yourself, even though the other person hasn’t said a word.  And it would not happen if you were talking in your car or talking at home or writing in your journal.

So the reality is that healers, if we’re thinking about what a healer is, almost all cultures have a designated role for a healer, because almost all cultures, speaking historically, are deeply spiritual.  The idea of medicine being separate from religion or spirituality is just not known.  Everything is spiritual.  And so the healer is the person who’s connected with the divine and has a special access to the divine.  And healers, in most cultures traditionally, don’t become healers because they say, “I want to become a healer.  Wouldn’t that be great?  Oh, my dad’s a healer and I can get a nice income and it’s certainly a lot of prestige and people like healers, and I’m interested in it, and I’ve read some books and I’m fascinated.”

No, that’s not why people become healers.  People become healers because they become sick.  They themselves go through a breakdown and anthropologically, I mean, the word “shaman” specifically comes from what’s now the Siberia region.  And so, I don’t want to impose one culture’s experience on all cultures, but there does seem to be enough commonality in the human experience for a term like “shaman” to be used in multiple different contexts.  Because often the shaman, the person who becomes that spirit healer, has not only had an illness, and it could be an addiction, it could be an injury, sometimes being attacked by an animal or an infection, an appendicitis or something, but often it’s madness.

If the person goes through a psychotic episode, they’ll just become wild.  They’ll stop communicating in the language that they know, and start just being this monstrous animal that runs off and lives this wild – and then it’s the elders, it’s the people who have the experience that come to that person and start to bridge into their reality.  And then frame it not as a, “how do we fix you?”  But “you’re going through an initiation.  You’re going through a transformation of your identity.  That your old identity, the sense of what you thought you were, and the sense of what your limits were no longer holds.  And your sense of your old identity is so strong that the only way you’re going to wake up to your gifts and to your potential is through a dramatic violent breakdown of that identity.”

And this is actually, if you talk to people, a lot of people have this experience.  That the idea of transforming the identity through suffering and through tragedy is actually intrinsic to the human experience.  A lot of people who, say, have a terminal illness diagnosis, some of them will say, “wow, it’s one of the best things that ever happened to me because I learned so much.  I really feel that my cancer was a gift.”  Now, if someone comes to you and they say, “oh, I have cancer.”  You don’t say, “congratulations, you’ve got a gift.”  No, the person may or may not discover that themselves.  And a lot of people don’t.  It’s just a flat out tragedy for a lot of people.

But for a significant number of people, there seem to be gifts that are discovered through suffering and gifts that are discovered through tragedy.  And tragedy can be transformative.  In fact, the presidential candidate, Marianne Williamson, she talks openly about how she was in a hospital in her twenties, that she had a nervous breakdown.  And for her, it was a breakthrough.  She learned from that experience.  It woke her up.

And so for a lot of us, these crises, these tragedies, these horrible experiences that we go through that break us down are wake up calls to another side of who we are.  Before I went into the psychiatric hospital system, I was very in my head.  I was convinced I was going to be a philosopher.  Everything was about books.  It was all intellect, intellect, intellect, verbal, verbal, verbal.  I still have that, certainly, clearly!  But at the same time, the hospital experience and the breakdown that I went through woke me up to my emotional side.  It woke me up to my relational side and now my work and my life is much, much more related and connected.  And I value human relationships much more than before I went through my crisis, where it was all much more in my head and intellect and abstract and analytical.

And so my crisis – one way of understanding it is that my crisis forced me to go through a big change that was very painful, but also to wake up to parts of myself that maybe needed attention.  And this is one of the reasons that I studied Jung, because this is the fundamental framework that Carl Jung has.  That the unconscious, the parts of us that aren’t aware and accessible to our intentional mind, isn’t just a repository of instincts and urges and repressed wishes and forbidden fantasies and primal animalistic urges, like in Freudian understanding of the unconscious, that needs to be controlled and modulated and kind of kept at bay.  And you sort of create a negotiated truce with your unconscious.

In Jungian psychology, the unconscious is part of nature.  And it’s understood ecologically that it has an intrinsic growth impulse.  And so the part of you that is cultured, that is stuck in an identity that you are who you think you are, may not be in line with what that impulse and what that growth wants you to be.  Because that growth and that impulse is aware of your potential.  It’s aware of your gifts, it’s aware of your talents.  So it’s going to push you in a certain direction that you may resist.  It may push, it may give you a symptom, it may give you a neurosis, it may give you a disturbing addiction or a destructive pattern, or it might give you an illness.  It might give you a crisis as a way of kind of doing a course correction, as a way of kind of compensating for the way in which your ordinary identity has drifted from what nature and the deeper psyche wants for you.

And what I find is that is often helpful for people.  But I will switch into a different register.  If that’s not helpful for someone, and they just need some discussion about what medication is best, or how they should deal with applying for a job, or they just want some relaxation techniques or some tools to help them sleep, I will also trust that that, again, is that person’s natural self and their own intuition.  And their instinct is that that’s where they need to be in that moment.  So I wouldn’t impose a Jungian model or a model of initiation and breakthrough and Shamonic transformation.  I wouldn’t impose that model on anyone.  But again, I think we do have to have that door open.  And psychiatry closes all those doors and just says, there’s one size that fits all, and if the meds don’t work for you, then take some more.

Ryan:  So having that lens can help us normalize and see it as potentially really important, really transformative, whether or not the person is ready to proceed in that way or to allow for it?

Will:  Potentially.  But I would back away from the idea of “ready,” because then it kind of creates a hierarchy.  I would say more like the person knows – they know best for themselves.  Sometimes the analogy that I would use is if there’s a chrysalis that you know is going to transform into a butterfly, you can’t tear away the outer of the chrysalis, because it destroys the process.  Or a chick that’s pecking through an egg.  You can’t tear away the egg.  The chick needs the resistance of the egg to strengthen itself, so that when it breaks through the egg, it’ll be strong enough.  I mean, I’m not an expert on chicken development or anything, but I think you understand the main point: you can’t force the process.

And I think we make a mistake if we have a developmental plan for the person.  And we say, oh, this person isn’t ready, or they’re not, because then we elevate ourselves.  Actually the person knows best.  And it’s also very individualistic.  Someone who seems stuck may actually be serving a role in their community or their family that you may not understand.  The context outside of an individualistic frame may help you to see that actually this person is totally ready, and they’re doing exactly what they need to do at this moment.  If I just have a different perspective.  What needs to change is my perspective that’s judging them as not being ready or them not being good enough, or them not having strong enough ego resources or not having the whatever sort of pathologizing ….

Because it’s a very insidious, judgmental, one-up expert, patient clinical gaze framing that I think we absolutely have to be very vigilant about because the potential for misusing power as a therapist is so magnifying.  I mean, power is a big problem interpersonally, in general, but the context of the doctor and the patient, or the therapist and the client is just a big setup for the misuse of power.  And I think it’s actually like a bind.  Like if someone comes into therapy, they’re sort of saying that they need therapy.  So it kind of creates a one down position to start out with.

I think that there’s a Woody Allen joke.  I’m going to ruin the joke, but it’s something about if you go to therapy, then, well, you must need therapy.  If you stop going to therapy, you no longer need – and there’s a kind of a truth to that.  And so you have to be careful as a therapist to work against the context, putting someone down and elevating the other as the expert, that the person is going to surrender their own inner wisdom, their own inner following to the direction of the other.  Because it can be intoxicating.  It can be seductive.

Therapists are going to play out their own unhealed, wounded gratifications.  And you have to expect that that’s going to happen.  You have to be able to be willing to look at it honestly and counteract it and address it.  And the good news is that when that starts to happen, it can become a resource for the therapy.  You can understand the people that you’re working with more deeply if you notice what it stirs up in you.  If someone sits down with you and you get frustrated and angry with them because they’re so stuck, that’s going to give you some insight like, “wow, maybe there’s a part of themselves that’s angry and frustrated.  Maybe they have people in their lives that are bullying them, are judging them.”  You can use yourself as a kind of sensitive instrument for reflection of what the other is going through if you have the awareness and if you have the honesty and the humility to see your responses that way.

Ryan:  So there’s all of that going on in us internally.  And then, myself included, I think that a lot of us struggle with sort of our own sense of what’s right, and then our obligations that we might have to regulatory boards, insurance companies, the settings in which we work.  And I think I’ve heard you say this elsewhere that we don’t often have spaces where we can talk about this openly.  So I wonder if you have any advice, comments you might want to make to practitioners who are struggling with these dilemmas beyond just some of the internal relationships that they have with power, their inclinations there, but also to some of these external forces.

Will:  It’s a great question.  And I don’t know if people are going to like the answer.  But first of all, get a day job.  Get a day job.  Do not be in a rush to have all your income coming from working as a therapist, because that puts a certain kind of pressure on you, and you have a choice to not have that pressure.  And once you’re under that pressure, it becomes easier to make the ethical compromises.  So get a day job.  Don’t just dive – everyone’s like, “oh, I don’t want to work at Starbucks.”  Why not?  I mean, especially if you can be part of unionizing at Starbucks.  There’s a lot of judgment in society about the jobs that we have.

I see a young person, very young person sometimes, in a healer role or a helper role or in a therapist role.  And I wonder, “how much life experience does this person have?”  And I’m not saying you can’t do it, but let’s be honest that there’s a lot of life experience that you get just from living life that then you can bring into being a healer or a helper.  The other thing that’s even a more deep answer is that I don’t think that you should start your work as a counselor or a therapist in a paid context.  I think that you need to start as a volunteer.  And for a lot of people, that’s going to AA, that’s being a sponsor in your AA practice.  It’s speaking at AA.  It can be volunteering with a helpline.  It can be volunteering at an agency or a nonprofit or volunteering to be doing listening and doing peer counseling.  And the reason I say start out as a volunteer, because you want to be clear that your motivation isn’t to get the mortgage and to get the car payment and to get – you want to be really clear that you need to do this in life.  This is who you are.  Volunteer at your church, volunteer somewhere and start to get into that role of being a helper.

Because if you don’t thrive on helping people, you should not be in this career.  If you don’t love people – I mean, everyone I sit down with, and I’ve worked with people who have committed acts of violence.  I work with people who are abusive.  I work with people who lie to me.  I’ve worked with some very icky people.  And then there’s people who have different political or religious views that I find problematic.  Some people are homophobic towards me in the session.  So it’s very challenging, the people that I work with.  But if I don’t fundamentally look at someone else and say, “wow, that’s a human being!   Human beings are really interesting!  I kind of want to learn more about …”  If I don’t have that affection towards humans, then I cannot do this job.

So find out if that’s you before you enroll in the degree program, before you sign up for the student debt, before you sign up for the career salary position.  And then once you have a connection with, “wow, this is really sustaining me,” you’re going to find a way to do it.  Whether you’re volunteering or you’re starting a support group, or you’re volunteering or you’re getting into a paid position.  And then you’ve got your day job that’s keeping the bills paid.

And then again, you see how immediately we’re in a conversation of what society we live in and what economy we have and what options are in the job market and housing and rent and all these kinds of – there’s so much pressure to go through school quickly and then land in the career and get the seventy, eighty, ninety whatever thousand dollars per year with medical benefits.  If we had universal healthcare and we had guaranteed universal basic income and we had a poverty floor, so that no one would be in poverty in society, people would be a lot of freer to explore their calling, right?  So you see how these issues are connected.

And then the other thing I would say to people, if you do have a calling and you’re not motivated by money, then you’re going to have to say no.  You’re going to have to leave the agency, quit the job, leave the group practice, stay away from certain kinds of contexts.  Don’t just go for something because it’s going to advance your career and you’re going to get the money and you have to do it.  Make sure you don’t have that pressure.  So you have the freedom to make those decisions.

And then, you used the word dilemma.  And I really like this word because a dilemma is exactly what we will face again and again and again.  Name the dilemma.  Stay with the dilemma.  Focus on the dilemma, discuss the dilemma, talk about it with your clients.  Sit down with your clients.  Say, “look, I am here to work with you.  I’m here to listen to you.  I want you to feel safe, I want you to feel trusting.  I’m going to do my best.  And I work in an agency where if you use certain words or you say certain things, I’m going to have to break confidentiality.  I don’t like that.  I don’t think that’s good for me or for you, but that’s the dilemma that we’re in.  What do you think about that?  Should we proceed?  Let’s work out a system, so that if you come in and one day you feel that you’re having suicidal feelings, that you can still get a good session with me without being afraid that I’m going to pick up the phone after the session and call …”

Have that conversation with people.  If you are sitting with someone, your client, and they need you to trust them and to be confidential, but you’re going to have to break that, because of the agency that you’re in – and you don’t feel good about it, talk about it with your supervisor.  Be respectful.  Don’t become the rebel, the fire breathing rebel that says burn down the system.  Although if you want to, go right ahead because I’m right with you!  But be strategic.  Say, “hey do we really need to interpret the confidentiality thing so strictly?  How much flexibility do we have to talk about suicidal feelings?  Do I have to just immediately ask ‘are you suicidal?  Do you have a plan?  Do you have a means?’  Or can I have a conversation with my client?”

Create that conversation in the agency and now you are a change agent for your institutional context.  Maybe you educate your supervisor.  Maybe you educate the director of your agency.  And now they come to the county-wide or the state-wide hearing and they have a different perspective.  And now maybe the laws and the regulations start to maybe get changed a little bit.

And I use the example of confidentiality because I think this is where a lot of therapists end up betraying their own ethical commitments.  And I think you need to be educated.  Don’t just say, “well, I had to call 911 because this person was going to kill themselves.”  No, you don’t – the power to predict a suicide has been demonstrated again and again and again – that psychiatry and psychology do not have that power.  It’s still a role of the dice.  You don’t have the ability to assess and then conclude.

What you can assess is you can assess whether there’s a risk of liability.  You can assess whether you’re going to go against the standard of care that your colleagues have.  And the fear and the safety are really about the professionals being afraid and protecting themselves.  And there’s extensive research on this – that the entire discipline of suicidology has been trying to answer the question: why is it that two people with exactly the same profile, history, risk factors, different means, plan – all the different things that we do in an assessment – why is that one person will end up attempting to kill themselves, and another person won’t?  And the answer is: we don’t know.  There just isn’t a way to predict.

So the entire industry of suicide prediction, assessment, and then you lock someone up, and then you force them into the hospital, and then you discharge them, and then you send them a bill, it’s based on bad science.  In fact, there’s a lot of evidence that the exposure to the psychiatric system increases the risk of suicide, that the highest risk of suicide is right after discharge.  And I would argue that we’re training people to not talk about their feelings because their feelings become forbidden.  You can’t talk about suicidal feelings because everyone’s going to get upset and then someone’s going to take your rights away.

And until you’ve actually had that experience of being hospitalized against your will, you don’t know how devastating and how traumatic and how infuriating and how trust breaking and incredibly betraying it really is for a lot of people.  I wouldn’t say for everyone.  Some people have a different experience.  But for a lot of us, it really is an assault and a kidnapping.  And then you’re often forced to take medications until you comply, and you say, “yes, I agree, I have an illness.  Yes, I agree to take my …” It, in effect, becomes a kind of torture.  It becomes a way of using punishment to reform someone’s thinking.  And there actually is a lot of legal perspective on this.

And you can say, “well, Will, you’re talking about widespread practices in the psychiatric industry.  If it really is violence, if it really is kidnapping, torture, assault, why is it so widespread?  How could that be?”  Well, actually the history of psychiatry is characterized by that.  We don’t have to go very far back in the history to realize that being gay or bisexual or trans – you ended up being lobotomized, electroshock, assaulted, tortured, killed in the psychiatric system.  That only changed in the 1970’s and 1980’s.  So we’re dealing with an industry that has a very bad track record of recognizing how it normalizes violence.

My belief and the belief of people in the mad movement is that we need equal rights under the law, that if you’re worried about somebody, then you’re worried about somebody.  If someone commits a crime, okay.  But if you’re worried about somebody, we need to find other ways to respond than creating a legal double standard where suddenly they don’t have rights because they have a psychiatric diagnosis.  The psychiatric diagnosis should not mean that the person does not have equal rights.  And the society of the disability justice movement has been saying this, it’s becoming more and more clear.  It’s a movement that’s slowly building.

But I believe that that’s where – that is the only ethical stance for therapists – you’re very far ahead of the curb, but then you’re in a dilemma.  So deal with the dilemma honestly, openly discuss it, think about it, discuss it with your colleagues.  If all of your colleagues think this is all crazy and this is just weirdo psychiatric stuff, then find other colleagues.  There’s a huge community out there of therapists, psychiatric nurses, social workers, psychiatrists, psychiatric nurse practitioners, GP’s, and naturopaths that are out there who are asking these questions, who are on this wavelength.

The International Society for [Psychological and Social Approaches to Psychosis] – I think I have that right – the ISPS – is a great organization to be aware of.  Mad in America is a great website to be aware of.  So yeah, they’re dilemmas.  There are no solutions to a lot of these dilemmas without transforming our society.  But you can have an honest, ethical response to a dilemma by naming the dilemma and doing the best that you can.  Because mostly what people say is, “oh, there is no dilemma.  It’s the right thing to do and we shouldn’t question it and just do it because everybody else does it.”  Following the herd, that’s a logical fallacy.  It’s a logical fallacy.

It really is the case that the normative mainstream mental health practices in the U.S. and globally today are absolutely abusive and violent.  I believe that there will be a shift, that society will – and we’re starting to get this with disability rights.  It’s parallel with animal rights.  That you might see treating animals like machines and just torturing them and tormenting them is completely normalized.  But there is starting to be a shift in society, that maybe we shouldn’t do this.  So be on the leading edge of that shift.

Ryan:  Will, I want to back up for a moment and talk about diagnosis.  And I wonder if we could start with a basic definition: what is mental health diagnosis?  And I’m also interested in hearing your thoughts or understanding of what some of the implications are.  Because as I was thinking about our conversation, I realized, “wow, this is so much bigger than just clients getting reimbursed for their sessions, right?”  There’s legal implications, and I’ve heard you talk about this with respect to human rights.  It’s a really big topic.  Why don’t we start with just how you understand it as a phenomenon and what some of the social implications are.

Will:  Well, we should be really aware that when someone has a psychiatric diagnosis, it can be an impairment.  It can be discrediting for them legally.  If you have a psychiatric diagnosis and you decide that you want to divorce your partner, now your partner is using that psychiatric diagnosis against you in court to get custody of your children.  This happens all the time, all the time.

You have a diagnosis, you want to get insurance, you can’t get insurance, because of a preexisting condition.  You can’t get life insurance.  These are the formal ways.  And then you are in a conflict with your neighbor.  Whisper, whisper, whisper.  So and so was diagnosed such and such.  Now your perspective in the conflict is devalued.  You want to go for a job interview, you want to go for political office, I mean, there’s an enormous number of ways that a diagnosis itself can be discriminatory and can be discrediting and devaluing.

Of course, the diagnosis of depression is maybe more mild.  But if you have a diagnosis of depression or you have a diagnosis of anxiety, what does that mean for how other people are going to see you?  The way in which there’s a stigma that’s attached to those things.  Some of the diagnoses are devastating.  You know, I don’t introduce myself as someone who’s diagnosed with schizophrenia.  It’s scary.  It’s a scary word.  I certainly don’t say I’m diagnosed with schizophrenia, and I don’t take medications.  It’s really going to scare – I mean, people immediately go to mass murder headlines.  They go to serial killer associations and horror movies, none of which is based in scientific fact.  We have as much of a stigma around mental health diagnosis as we did around being gay and bigotry around racism or sexism. So we have to really recognize that the label itself can be very harmful.  So that’s one thing.

The second thing is that I think that the labels carry a certain kind of false expectation about what is help.  If you have depression, then you should be on antidepressants.  If you have schizophrenia, you should be on antipsychotics.  If you have anxiety, you should be on anti-anxiety drugs.  In fact, we’re actually – we name the drugs as the antidote to … whereas actually, there’s no chemical imbalance associated with depression.  The dopamine theory of schizophrenia has never been proven.

And the effectiveness, if there is … because antidepressants are not much more effective than placebo, for most people, it comes from expectation.  It comes from the placebo effect.  It doesn’t come from treating some correcting chemical imbalances.  The effectiveness of benzodiazepines is because they’re tranquilizers.  The effectiveness of antipsychotics is because they’re tranquilizers.  Lithium is a tranquilizer.  People have said, “oh, well, I responded to lithium, therefore that confirms my diagnosis of bipolar.”  No, it doesn’t.  It confirms that lithium is a useful substance for you, wrapped up in all the expectations.

Some people will get better just from going to a medical professional and then following what the medical professional says.  The ease, the sense of relief, the sense of I’m doing the right thing.  So there’s a set of messages that go along with diagnoses that I think we need to scrutinize.  And they limit our thinking about what’s possible.

When you’re diagnosed with schizophrenia, it’s hard for you to do a mental shift: well, actually maybe I’m a child abuse survivor.  Or actually, I look at my family, I look at the extreme neglect.  I had three sisters, all of whom were very, very expressive and got a lot of attention.  I was the good kid.  I was the one who was never worried about.  I never cried.  I never had a problem.  I was always kind of invisible.  Then later in life, I get diagnosed with bipolar psychosis.  One of my main symptoms is mutism and withdrawal and hiding.  You see the connection?  There might be a connection there.

So these are processes of human discovery.  And fundamentally, if we rob someone of the right to discover for themselves, I don’t have a problem if someone says, “my identity is having a bipolar disorder.”  I don’t have a problem If someone says, “my identity is my sun is in Scorpio and my moon is in Virgo.”  I mean, if these are explanatory, I want to find out what they mean to you.  Someone says, “well, I had an episode, I had a bipolar episode,” my response won’t be, “well, actually bipolar doesn’t exist and it’s based on bad science, and this is clinical language.”  That’s just going to create a power struggle with the person.  My response is, “okay, what kind of bipolar episode did you have?  How did you know you were in a bipolar episode?”  “Oh, well I just, I suddenly …”  “Well, was it really sudden or was there a buildup?  Were there things that led up to it?  What were some of the early warning signs?”

I think that when we talk about bipolar disorder, we get very confused about sleep deprivation.  The reality is that if someone doesn’t sleep – anybody, if you don’t sleep, you’re going to go psychotic.  End of conversation.  Anyone will become psychotic if they’re sleep deprived.  That says to me that psychosis is a possibility of the human psyche that’s universal.  Rather than seeing it as specific to a disease.  Now, if you put ten people in a room and you sleep deprive them, some of them will start hearing voices and start going through hallucinatory experiences earlier than others.  Does that mean that some people have bipolar disorder, and some people don’t?  Well, no.  They all have the capacity to go into a manic or a psychotic state from the sleep deprivation, just that they have individual differences.  So some people may be more susceptible to sleep deprivation.

I know for me, if I don’t get sleep, it affects my wellbeing very severely.  And if I consistently don’t get sleep, I will unravel and I will start to head into a psychotic crisis.  We’re surrounded by people who are adapted to a sleep deprived culture.  You go to college, everybody else is pulling up an all-nighter.  “Oh, I’m pulling two all-nighters.  Give me some Adderall so I can do a third all-nighter.”  Your friends might be able to do that; you can’t do that.  Diagnosis shuts down that entire conversation.  We don’t actually learn, and then we don’t learn pathways for empowerment.

If you have a diagnosis for bipolar or you have a diagnosis for schizophrenia, what are you going to do?  You got the disease.  You’ve got to do the disease treatment.  You’ve got to do what the doctor says.  You’ve got to do the meds.  Where is the possibility for saying, “oh, well, actually I stopped eating gluten and I noticed that my head is clearer, and I have less anxiety and I’m less prone to paranoia.”  I have talked with several people who had a schizophrenia diagnosis.  They stopped eating gluten and that was it.  They no longer had any symptoms.

Now is that the power of their own being convinced that that was the solution?  Was there a confounding factor?  Was there something else that changed in their life?  They just got older or – I don’t know.  But that’s their experience.  And again, it comes back to what I was saying.  I would never program and say, “everybody is having a Shamonic awakening who goes through a schizophrenic …”  You have to explore possibilities.  That means listening.  That means taking time.

Diagnosis is about the assembly line.  Diagnosis is about you get somebody in, you stamp them with a label and then you move them into the right chute for the right treatment.  Which is exactly how I want the doctors to respond to a car accident.  I want them to know: this person’s bleeding out.  This person has a fracture that needs to be stabilized.  This person looks fine, but they have a concussion, and we need to monitor them.  And I want the doctor to find out as quickly as possible.

That is a disastrous model for mental health.  We need the opposite.  We need to take the time to explore the meaning with the person.  If I come in with a broken arm, I don’t want my doctor to listen to me when I say, “oh, I’m fine, my arm is broken.”  I want my doctor to say, “when I press you here and when I look at this x-ray, I see a fracture.  We better get this under a splint, and we better get …”  I want my doctor to follow them against my own voice.  I want my doctor to silence me if they’ve got – now obviously I’m using broken arm because it’s a more extreme example.  And there’s a lot of gray area even in so-called physical medicine.  But I’m setting that aside now cause I’m trying to make a point.  The medical model of which diagnosis is central is about sorting people quickly into treatment so that you can move them along to the next station in the factory conveyor belt system.

Ryan:  … transposing that onto psychiatric mental healthcare.

Will:  Exactly.  And completely wrong headedly.  It’s a categorical mistake from a philosophical – we’re using the wrong framework.  Now, if you look at the origins of diagnosis, we think that, okay, the diagnosis, someone’s in distress, they get a diagnosis and then they get treatment in a hospital.  Actually, the origins were exactly the opposite.  They rounded people up into asylums first before they had any idea.  And then they went through and sorted them, and they said, oh, this person has dementia praecox, which is what – this person has manic depression.  This person has this.  They had no idea about mercury poisoning or syphilis or encephalitis or Alzheimer’s disease or dementia or alcohol delirium or Down syndrome.  It was all thrown into the same bucket.

And that kind of gathering of human experience and putting it into a category may have been useful from a certain policing and control of getting the people off the streets, because they were also getting poor people off the streets at the same time.  It was about the growth of cities and the development of industrial capitalism, putting people in poor houses and starting to control populations, because there were more people living in industrial urban settings.  And that was then.

But now we’re using the same framework.  We’re using the same framework.  It’s a disaster.  There’s a big movement within psychiatry among psychiatrists and among psychiatric researchers to stop using schizophrenia.  If you interview twelve people with a psychiatric diagnosis of schizophrenia, you will get twelve different sets of symptoms.  It’s way too diverse.  It’s a catchall.  It’s like a bucket that it all gets thrown into.

I think it’s more interesting to talk about experiences.  Let’s talk about the hearing voices experience.  Okay, hearing voices, you would think, okay, auditory hallucinations are one of the cornerstones of a schizophrenia diagnosis.  Wait a second.  Back up from the diagnosis.  If you talk about hearing voices, you discover very quickly, the majority of people who hear voices in society don’t have any diagnosis at all because they have no distress from hearing voices.  Hearing voices is actually very respected and an ordinary part of life.  Just like being gay is an ordinary part of life.  Except it has the stigma, it has the homophobia on top of it, which is what we put on hearing voices.

So, what if we studied hearing voices and we said, “why do some people who hear voices hear the voice of God, or they hear the voice of their muse, or their voice dictates poetry to them – like Paul McCartney hears voices.  So why is it that some people have a positive experience, and some people have a negative experience?  Why is it that some people who have a negative experience seem to do well and other people don’t?  Oh, they’ve learned coping skills.  Oh, it’s about isolation.  This is the kind of framework that we need to have.

What I do in my work is that I step back from the diagnosis.  Someone says, “Will, I’m hearing voices.”  I’m like, “oh, and?”  “Will, I go through these incredible mood fluctuations.”  “Oh, okay and?”  “Will, I have these terrible bouts of depression.”  “Oh, okay, and?”  Because I know someone who’s hearing voices might be doing really well in life.  Someone who has wide mood fluctuations might just be very creative.  Someone who has depression might just be going through grief in their life.  Or a lot of artists will say, “yeah, I go through a depressed period and then boom, I come out of it, and I have this massive creative period.  And then I finish my painting and I get depressed again.”

Sherlock Holmes … when I was a kid, I was fascinated with Sherlock Holmes.  When Sherlock Holmes was on a case, he was happy as a lark because he was just completely passionately involved with his case.  When he didn’t have a case, he was depressed, and he used cocaine.  Now we can diagnose Sherlock Holmes as manic depressive and try and figure out a way to treat him for his manic depression.  What if we just give them more cases?  You know, what if we just find out what supports and helps that person and let that person find their own way with what it is that they’re going through.

Because all of these experiences that go into the DSM are very curious.  It says you experience voices, you’re out of touch with reality, you have wild mood swings, you go through incredibly depressive withdrawals, and it interferes with the functioning of daily life.  Every single diagnosis is not about the experience, it’s about the experience relative to the context.  Why are we focused on the experience as a symptom of a disease when the very diagnosis says, well, it may or may not be depending on the context.  Let’s study the context.

For me, what I see is not people that have a disease or disorder.  I see people that seem to be suffering from two main things: one is a sense of isolation in the world, and two is a sense of disempowerment.  They’re out of control and they’re alone.  And control can come from having a place that you can afford for rent.  It can come from being able to stay away from your abusive ex-boyfriend or your intrusive parents.  But it can also be control that comes from meaning.

And one of the books that I often recommend, it’s even a cliche to recommend it, is Man’s Search for Meaning by Victor Frankl.  Because in the starkest ways, it demonstrates that people are able to create meaning and a sense of control in their life from the craziest circumstances.  So yes, we need to prevent the Holocaust from ever happening again.  And yes, the responsibility for that is on the perpetrators, the Nazi perpetrators.  But when you’re in the camp, you still have some power.  You still have some choices that you can make.

So how do we help people make those choices?  How do we help people look at their situation?  Diagnosis is unnecessary.  When someone is in a domestic violence situation – usually it’s women – we help them without diagnosing them.  We don’t give them the diagnosis of masochistic personality disorder.  We don’t say, “oh, this is your fourth abusive boyfriend, therefore you need to take meds.”  No – there was actually – if you look at the history of psychiatry, there was an initiative to do just that.  And the women’s movement just pushed back on that.

There was masochistic personality disorder, and they knew that it was going to be associated with domestic violence survivors and women who stay in abusive relationships, which is really a thing.  But I hope that every listener is going to understand that women who stay in abusive relationships have good reasons for staying in abusive relationships.  There’s a context.  So we can help those people who are in domestic violence situations without diagnosing them.  We don’t have to diagnose them.  Just put money into the services, then knock on the door: “hi, do you need domestic violence services?  Yes, come on in, let’s give you those services.”

Homelessness.  Do we diagnose people who are homeless with persistent domicile deficiency disorder?  Do we say, “oh, why can’t you keep a home?  Why can’t you keep a job?  You seem to go back in the streets over and over.  Why is it that your couch surfing, but somebody else in the exact same situation was able to keep their home?  Oh, it must be because you have a disorder.”  We don’t do that.  We just say, “you have homelessness issues.  Come on in, we’re going to give you services.”  That’s what we need to do with counseling.

And most therapists, they do this.  Someone comes to you and you’re grateful.  “Oh, I have a client.  Great, let me help you.”  And you work with them.  And then most therapists – there actually has been some research on this.  When it comes time to bill insurance, most therapists tend to be reluctant to actually give that DSM code and they’ll go with adjustment disorder, which is the mildest, or they’ll go with PTSD.  I will discuss it with the client, and I’ll say, “look, this is a dilemma.  I want this insurance payment.”  I generally don’t take insurance because I didn’t go that licensed regulation route, which is one way of dealing with the dilemma is to go outside of it entirely.  But I sit down with the client, and I say, “look, this is a dilemma.  If you want to get reimbursed, we have to come up with a diagnosis here.  What should we, what should we do here?”

So there’s lots of different – I don’t think we need psychiatric diagnosis.  I think it’s basically a scientific fraud.  The decisions about what goes into the DSM are decided politically.  There’s literally power struggles at the height of these committees about which one to kick out.  And then they change it.  “Well, grief, is it six weeks or eight weeks or twelve weeks normal grief becomes depression?”  Well, I mean, it’s a fraudulent endeavor and it’s not necessary and it’s also harmful for people.

Ryan:  It’s also very interesting to look at the history of what gets included or excluded with each version of the DSM.  Some diagnoses get center stage at one particular time, and then they fade into the background later.  Or one diagnosis really starts to change in terms of its criteria.  So what is it exactly that we’re …?

Will:  Yeah, one day being gay is in the DSM, the next day it’s out of the DSM.  The trans community is in a big dilemma right now because there’s nothing – if you have gender dysphoria, is the problem in you or is the problem in society, not having a gender affirming society?  Someone who has gender dysphoria doesn’t have a mental illness or a disorder, but to get the insurance coverage, to get the services – so there’s a dilemma there.  It can change overnight.  Being gay, one day it’s a disorder, the next day it’s not a disorder.

The history of the word hysteria, if I say someone is hysterical, it’s a misogynist slur.  It’s clearly a misogynist slur to tell a woman that she’s hysterical, yet that was medical science.  And then they changed it to borderline.  Of course, very quickly, that has now caught up.  If you want to discredit someone, if you want to throw an epithet at someone, call them borderline.  It’s an incredibly discrediting – the vast majority of people with that diagnosis are sexual abuse survivors.  And the trauma of their sexual abuse was so devastating that they’re still suffering the effects.  That’s why they are exhibiting the so-called symptoms of so-called borderline personality disorder.  Yeah, your relationships are going to be super unstable if you were sexually abused by a family member.  And that still has not been resolved.  You’re still carrying that with you.

So the diagnosis is very dangerous.  I think until you’ve actually experienced being discriminated against based on a diagnostic label, you don’t get how harmful the labels can be.  So that’s one of the biggest dilemmas we face as therapists.  I stepped out of the industry entirely because it’s based on – these things start to add up – there’s so many reasons that the industry is problematic that I just said, I’m not going to be part of it.  Obviously, a lot of people can’t do that the way that it’s set up with insurance and qualifications and credentials.  But we have to be honest about these dilemmas.  We have to face them, honestly.

Ryan:  I was thinking about asking you whether there’s any redeeming qualities to diagnosis, but I’m almost hearing that –

Will:  Well, I mean, it depends.  If it’s imposed, if there’s an imposed diagnosis … again, I come back to that feeling of hope and the possibility of change.  There’s a difference between the power relations of someone imposing something on you without even – we need informed consent about diagnosis.  Like, you’re going to come into my office.  I could give you a diagnosis.  It could stick with you for the rest of your life.  It could be used against you, it could stigmatize you, it could confuse you.  So we have to be clear what we’re talking about.  And it’s the difference between an imposed one.

But then, of course, the process of – I mean, it’s incredibly fascinating to read, especially the – not so much the DSM.  The DSM is such a behavioralist objective.  These are the observed traits.  But reading the psychoanalytic literature, which is vast and subtle and nuanced, wow, you can discover a lot of things about yourself.  Reading R.D. Laing’s The Divided Self is one of the best.  But there’s many, many – even Freud, I mean, you can discover so many things about yourself.  But any system or any category or any label, it can also mislead.

At some point, you’re reading all this psychoanalytic diagnostic literature and you’re, “oh, I have these traits and I have this pattern, and these are my object relations and this is my attachment problem and this is my style.”  And then you sort of realize one day, “wait a second, this is an individualistic framework.  I’ve been totally misled by one system by its own unexamined assumptions.  And now, wow, now I’m taking a look at my entire life as an expression of the relationships that I’ve been in.  I’m looking at family systems therapy.  I’m looking at ancestral healing.  I’m going into spiritual direction.”

I have a colleague who is diagnosed with psychosis and bipolar.  One of her symptoms, that was called “symptoms,”… incredible mistrust and hiding.  And she would stay in her apartment and only come out at night to put the garbage out because she was so scared of being seen.  And you could say, “well, okay, let’s look at the neglect in her family.”  And she did have a lot of bullying and neglect and abuse from her father.  But if you talk with her, you realize that her family are Holocaust survivors.  And the incredible persecution and fear and ancestral trauma that we’re now learning can actually be transmitted genetically.

So if we’re aware, a diagnosis and a diagnostic system can be helpful if we treat it for what it is.  It’s a certain perspective and an opinion that you’re trying on that’s going to have limiting effects as well as opening effects in terms of discovering about yourself.  And that takes a much more nuanced conversation which isn’t presented in the hospital.  They say, “oh, you have tuberculosis, you have a broken arm, you have bipolar.”  It’s just given as an objective without any kind of conversation or any kind of honesty about the epistemological character of that label that you’re being given.

So I mean, I think any system is interesting.  I think it’s very interesting to study far out … I mean, I’m such a strong anti-behaviorist.  I think Skinner is a dangerous – I think that’s terrible.  But read it, it’s interesting.  You learn a lot about how society works, about how commodities and how groups and how individuals are being manipulating and controlled and system of reinforcement.  And it’s abhorrent.  Any system that says there is no consciousness, you’re just a black box of reinforcement and punishment is morally repugnant to me.  But why not learn from that?  Learn from everything, I guess.  I have no objection to learning from everything, I guess is what I’m saying.

Ryan:  It helps us understand how we got here.

Will:  Exactly.

Ryan:  So before we start to wrap up, you’ve talked a little bit … you’ve referenced certain projects and paradigms that you feel drawn to.  And it sounds like, especially, some of these are happening internationally, in other places besides the U.S.  Can you talk about some that are inspiring you and that listeners might be able to learn more about?

Will:  Yeah.  Well, I would recommend people check out the ISPS, which is an international professional’s association of a lot of people who are thinking differently about psychosis and mental health.  Mad in America is a great resource, is kind of a hub, an international hub.  There are also Mad in America is in different countries in different languages as well.  Some of the leading initiatives that I think people need to be aware of and connect with: the first is the psychiatric survivor movement.

There’s an entire mad movement out there.  It’s thriving on social media.  It’s thriving in different forums, different organizations, different gatherings.  The mad movement has established a certain amount of support and legitimacy in funding, which is a mixed bag, in the peer specialist industry, the way in which peers are now being hired.  People who have lived experience just as someone who maybe is a survivor of addiction and comes out of a twelve-step process is then hired and credentialed as an addiction counselor.  We also have that happening with other mental health context as well.  So I would check that out.

Some of the main initiatives, the Hearing Voices movement, which has been really pushing for support groups where people are able to talk about their experience and push back against this idea, first of all, that patients shouldn’t be talking to patients because it just makes them crazier.  Which is – okay, maybe that’s true in some contexts, but overall, people connecting with each other is better than people being isolated.  And it also pushes back against this idea that you can’t talk about a so-called psychosis.

This is very strange to me.  If you’re not going to be isolated and you’re going to find meaning and you’re going to start to get some empowerment about your life, how are you going to do that without talking with other people?  So this prohibition against talking about psychosis and you just check the box, psychosis present, we don’t talk about that, we medicate it us being pushed back by the Hearing Voices movement where people come and talk about – I mean, if someone had asked me, “what is your voice telling you?  Is it a familiar voice?”  It would’ve really helped me to connect the voice that I was hearing when I was in the hospital with the abusive messages that I got from my father.  Because one of the voices that I hear is my father’s voice.  So there’s also Open Dialogue, which is an extremely important innovation that comes out of family therapy.

And the idea in western Finland that we need adapted treatment, that just medicating a disease model wasn’t client-centered enough, that we need to talk about the family and the context.  And it’s a tremendous paradigm shift because again, it looks at mental health problems, not within the individual, but within the social context, that it’s a breakdown of relationships.  And that by working with the social context, which is primarily the family, but it can also be friends or colleagues or other therapists or partners or people in the person’s relational matrix, you could say, that that is what can be helpful to rebuild the person’s life and keep them in their natural context rather than pulling them out, putting them in a hospital and giving them a new identity.

And then also the research around Soteria houses, which is very interesting.  It didn’t get the political support and funding that it deserved, but basically it was, you take people who were having that first break, mostly young people, that so-called first break.  And you don’t medicate them, you just give them a safe place to be, and you spend a lot of time with them.  You hang out with them, you listen to them, you talk with them.  You keep them safe, but not in a coercive way.  If they run out the door, you run out with them and just, “hey, what’s going on?”  And it turns out that a lot of people got better without medication and would go through their experience and would actually find their experience to be helpful and growthful given the opportunity to have that space.

So there’s a lot of different avenues for people to explore.  And the main message is if you are a professional or you’re thinking of going into the industry and you have any kind of openness or resonance with these ideas, don’t be alone.  Find colleagues, find groups, find other people, people at your workplace, people in the community, people from the school, people online who have your similar background and similar interests so you are not isolated.

Because I cannot tell you how many people I’ve met who go into the mental health profession and they just get beaten down.  They just get burnt out.  They just get hammered and they know things are wrong and they get tired of speaking up.  They get tired of the pushback from their colleagues.  They get tired of being the one who’s questioning things and they just get molded and adapted.  Don’t let that happen to you.  Find your community, find your connections to sustain that swimming against the tide.

Ryan:  That’s exactly why I think it’s important to name and to talk about some of these alternatives that exist, because many practitioners don’t even have a knowing that these alternatives are out there.  So it’s just a feeling of hopelessness and despair.  But when we can actually identify some projects that are working, it provides some motivation for actually changing.

Will:  Yeah.  I’ll take this opportunity to promote my work madnessradio.net.  I have more than two hundred interviews and there’s a number – mostly they’re with survivors, but a number with all kinds of different people connected to these issues, including a number of professionals.  And also my book Outside Mental Health: Voices and Visions of Madness, which you can buy, and you can also download for free if you go to outsidementalhealth.com.  And it has a number of edited interviews with different professionals.  We’re talking about some of these things.  So I think people will find that interesting.

Ryan:  And I think you’ve left out one more important website, which is your own.  Do you want to say …?

Will:  Yes.  There’s willhall.net.  In addition to Madness Radio and Outside Mental Health, there’s willhall.net and there’s a lot of resources there, including the guide that I wrote, the Harm Reduction Guide to Coming Off Psychiatric Drugs.  We didn’t talk about it as much in this interview, but a lot of people have some basic questions.  And so the guide tries to fill some gaps, not from an anti-medication or pro-medication perspective, but just answering questions for people, including what might I need to think about if I’m considering reducing or coming off my psych meds?

Ryan:  I love that that guide is freely available and also translated into many languages, I noticed.

Will:  Yes, it’s free, it’s in many languages, and there’s an audiobook as well that you can download.

Ryan:  Well, Will, thank you so much for your time, and sharing so generously.  I appreciate having you.

Will:  Ryan, it’s been great joining you today.  Thanks for inviting me.