Asheville psychiatrist Daniel Johnson didn’t set out to transform his profession. But he’s now part of a growing movement, both locally and nationally, that’s challenging the most fundamental assumptions about mental illness.
Dr. Johnson launched a private practice here in 2010 and, like most psychiatrists, he prescribed medications for his patients. But a controversial article he read nearly a year and a half ago got him thinking and eventually led to a profound shift in the nature of his work (see sidebar, “By the Book(s)”).
“Unfortunately, and sadly, more often than not, medications do more harm than good,” Johnson now maintains. “And of course I had contributed to all that in my own practice. I had a lot of soul searching and reckoning to do on a personal level.”
Nonetheless, Johnson — a graduate of the UNC School of Medicine who spent several years working in Mission Hospital’s inpatient psychiatric unit — says he did “a lot of apologizing” to clients, including those who later experienced a difficult withdrawal from a particular antidepressant he’d prescribed: “They put a lot of trust in me, and I feel like I led them astray.”
Many in the field would disagree with that position. And while Johnson says he’s gotten some support from colleagues, psychiatrists who help patients safely withdraw from psychiatric drugs are few and far between.
Asheville resident Faith Rhyne, a former patient of Johnson’s, says, “There’s something very reductionist about the conventional approach to mental health, which … really is that you have a chemical imbalance, and it’s a disease, and you have to take medication in order to fix that.”
With Johnson’s help, she’s been off psychiatric meds for more than a year. “I feel so much better,” she reports.
Rhyne belongs to the Asheville Radical Mental Health Collective, one of several local alternative support networks (see sidebar, “Helping Hands”). “You are more than your diagnosis,” she declares. “You are more than whatever quick answer might have been handed to you.”
What started Johnson on his revisionist journey was an essay by Dr. Marcia Angell, a former editor at The New England Journal of Medicine, that reviewed three books condemning the use of drugs to treat mental illness.
Although the essay sparked push-back from the medical establishment in the form of letters to the editor, for Johnson, those books’ conclusions “opened my mind to a line of thought which challenged a lot of my convictions but also made a lot of sense, and presented a very compelling argument for re-examining the work I do.”
Around the same time, Johnson decided he was tired of fighting with insurance companies, so he stopped accepting insurance altogether. That, he says, forced him to listen more closely to what his patients were actually saying rather than trying to align what they told him with the Diagnostic and Statistical Manual of Mental Disorders so he could get reimbursed for services rendered.
Johnson’s quest to learn more about the subtleties of medication withdrawal led him to the work of Dr. Peter Breggin, a Harvard-trained psychiatrist basaed in Ithaca, N.Y., who’s written extensively about the dangers of psychiatric drugs and electroconvulsive therapy. Breggin’s website (breggin.com) warns that psychiatric drugs are dangerous both to start and to stop, and the latter should be “done carefully under experienced clinical supervision” to avoid “life-threatening emotional and physical withdrawal problems.”
To safely taper patients off their medications, Johnson works with two compounding pharmacies in town, which create successively smaller doses of the drugs, rather than the standard dosages available from pharmaceutical companies. Depending on the number of meds involved, the process may take a couple of years. In addition, individual and group therapy help patients process what they’re feeling.
Once they’re weaned from the drugs, says Johnson, they can get a clear view of their inner self and are better able to do grounded bodywork with some of the many alternative and complementary medicine practitioners in town.
“When people start believing that there’s hope that they can live off of meds, that sense of self-empowerment … can be transformational,” he reports.
Bat Cave residents Lisbeth Riis Cooper and her husband, Don Cooper, on the other hand, take a somewhat more nuanced stance concerning psychiatric drugs.
In response to their own frustrations navigating the mental health system with their teenage daughter, the couple founded the CooperRiis Healing Community in 2000. The local nonprofit runs two holistic, residential treatment centers for people with mental illness or emotional distress — one on a Polk County farm and the other in Montford — that take what the website (cooperriis.org) calls a “medication optimization” approach which “supports the judicious use or non-use of psychotropic medications, based on evidence from methodologically sound and responsibly interpreted research studies.” Options include balancing med use with other services and supports, postponing their use, combining medication with other approaches to minimize their use, or avoiding them altogether.
The treatment centers, says CooperRiis Executive Director Virgil Stucker, focus on “empowering choice by the individual — informed choice that helps them know when medications may be useful and when not, especially over the long term.”
Further expanding the boundaries of their work, the Coopers pledged $2 million IN 2011 to the newly formed Foundation for Excellence in Mental Health Care, whose board chair is Stucker. The foundation aims to promote better mental health outcomes by highlighting existing research, developing and funding new research, and helping launch new programs.
One of those programs, the Asheville-based Mother Bear Community Action Network, provides support to families with relatives facing mental health challenges, says Jennifer Maurer, the project’s communications and program director.
Last fall, the fledgling nonprofit partnered with a Toronto-based group to produce an online mental health education course. Mother Bear plans to offer the course again this spring, says Maurer, and is also working on launching local family support groups (called “dens”) and a “warm line” offering non-emergency phone support for families as well as access to recovery resources.
It’s all done through the lens of the recovery movement, which is fueled by people who’ve gone through the mainstream psychiatric system and received a label, Maurer reports.
“You hold the potential that full recovery is possible,” she explains. “These challenges are not necessarily lifelong, degenerative, chronic diseases.”
The Asheville Radical Mental Health Collective, meanwhile, approaches mental health challenges from a completely different vantage point: the mad pride movement, which seeks to destigmatize mental illness and give those dealing with it a greater voice.
Formed in 2005, the Asheville group was inspired by The Icarus Project (theicarusproject.net), a New York City-based online forum and support network whose tag line is “navigating the space between brilliance and madness” and whose mission includes forging a new culture and language around mental health.
Members of the collective meet weekly in a corner of The Downtown Market on South French Broad Avenue, says Rhyne, who joined the group in 2009. They share their stories and offer one another support and information.
“I think there’s something really powerful when you have the wholeness of yourself and your story and your experiences recognized and affirmed,” she says.
Pulled into the psychiatric system at a young age, Rhyne says the experience “impacted my life hugely for years and years and years.” Diagnosed with a “severe, persistent disorder,” she ultimately didn’t find the conventional approach to treatment helpful.
“I felt very alienated from the common human community,” Rhyne recalls. The collective, she says, gives her “a space to just be myself.”
These days, Rhyne maintains her mental health through sensible sleep and nutrition habits, fostering connections with other people, learning to deal with stress, and having activities and an occupation — she’s a certified peer support specialist for others facing mental health challenges — that resonate with her and reflect her interests.
“Al” (who didn’t want his real name used) began attending the collective’s meetings after a “very, very hard time last year.”
“What I’ve gotten from it is an opportunity to share my experience in a safe place with people who understand what it can be like to feel isolated,” he reveals.
Instead of seeking a mental health diagnosis and medication, Al says he’s sustained by the collective’s support, sessions at All Souls Counseling Center and alternative approaches such as CranioSacral therapy and Somatic Experiencing.
And while he and Rhyne don’t entirely agree concerning the merits of psychiatric medicine, that’s perfectly acceptable, the collective maintains.
“Meeting people where they’re at and respecting individual choice is so core to what we’re trying to do, which is create that space of exploration where nobody’s going to tell you what’s right for you,” says Rhyne. “We all have the right to make personal choices about our health.”
Asheville writer/editor Tracy Rose can be reached at Tracy.B.Rose@gmail.com.