The Problem with Psychiatric

Funk & Wagnalls New Comprehensive International Dictionary of the English Language – 1980

Psychiatry: The branch of medicine that treats disorders of the mind or psyche, especially psychoses, but also neuroses.

Psychiatrist: A medical doctor specializing in the practice of psychiatry.

Webster’s Third New International Dictionary – 1971

Psychiatric: 1) related to, employed in, or of concern to psychiatry; 2) engaged in the practice of psychiatry.

One would assume than that psychiatric is an adjective referring to the practice of psychiatry. Yet SEE how is it used in the following sentence which is derived from the American Psychiatric Association site in on the internet.

Psychiatric management includes a specific set of interventions, some of which have been included in the concept of “supportive psychotherapy” and/or “insight-oriented psychotherapy” and others in the concept of “clinical management.”

Would not ‘psychiatric management’ refer to the management of psychiatrists? And wouldn’t the management referred to be the psychological or clinical management?

How about this sentence from the same material.

The psychiatrist should remain vigilant for changes in psychiatric status.

Does this mean the person’s status in regard to having a doctor? Or perhaps, it means that the psychiatrist is concerned about changes in his/her own status. Will s/he be disbarred from further practice? Or perhaps s/he is expecting a promotion.

It should be clear that psychiatrists consistently use the term inappropriately. The question is what is the purpose? Any reasonable reader should be able to sense the self-promotion that occurs in writing by psychiatrist. By attaching the psychiatric label to things, they try to indicate ownership, however inappropriately. My favorite is psychiatric rehabilitation. While I certainly agree that most psychiatrists need to be rehabilitated, I don’t think this was the intent. The real intent was to take over responsibility for what used to be known as psychosocial rehabilitation. This was a nonmedical practice working with severe and persistent problems in living, lovingly known in the trade as ‘chronic mental illness’ or ‘chronic schizophrenia’.

If we examine these terms closely, we find even more difficulty with ‘psychiatric’ language. “Chronic” is true only because of the inept services offered by psychiatrists. People with schizophrenia get better over time, providing they can avoid the debilitating effects of neuroleptic drugs. And ‘illness’ is a simple metaphor [See the Myth of Mental Illness, by Thomas Szasz] and is not truly applicable to any mental state except dementia or Alzheimers.

Such self-serving survival methods have caused some people to begin to react as the following three quotes would indicate.

Prominent psychiatrists are stating that schizophrenia is a brain disease like Alzheimer’s, Parkinson’s, or multiple sclerosis. These statements are disconfirmed by scientific facts: no neurologist can independently confirm the presence or absence of schizophrenia with laboratory tests because the large majority of people diagnosed with schizophrenia show no neuropathological or biochemical abnormalities and a few people without any symptoms of schizophrenia have the same biophysiological abnormalities. People with schizophrenia do not usually progressively deteriorate: most improve over time. Psychotherapy and milieu therapy, without medications, have led even the most severely disturbed individuals with schizophrenia to full recovery and beyond. Many people diagnosed with schizophrenia have recovered on their own without any treatment, something never accomplished by a person with Parkinson’s, Alzheimer’s, or multiple sclerosis. Unethical Psychiatrists Misrepresent What is Known About Schizophrenia by Al Siebert, Ph.D.

“Psychiatry is probably the single most destructive force that has affected American society within the last fifty years,” states Thomas Szasz, Professor Emeritus of Psychiatry at the University of New York and Lifetime Fellow of the American Psychiatric Association.

I also faced an investigation into my behavior as chief of the National Institute of Mental Health’s Center for Studies of Schizophrenia and was excluded from prestigious academic events. By 1980, I was removed from my post altogether. All of this occurred because of my strong stand against the overuse of medication and disregard for drug-free, psychological interventions to treat psychological disorders. “I Want No Part of It Anymore” Loren R. Mosher, M.D. – upon resigning after nearly three decades of membership in the American Psychiatric Association.

One wonders why we take psychiatrist so seriously. I visited their site to determine whether there were medical protocols for psychiatry. What I found were Guidelines for Psychiatric Practice in State and Community Psychiatry Systems

The introduction to all of the practice guidelines started this way”

Traditionally, state offices of mental health and state hospitals have been headed by psychiatrists. This is no longer true for these settings nor for community mental health programs. In recent years, one result of this trend has been that the comprehensive, biopsychosocial expertise brought by psychiatrists has been absent in many cases. This has negative consequences as serious mental illnesses are in the medical domain. State and community systems are responsible for the care and treatment of large numbers of persons with the most serious mental illnesses. The quality of this care must be assured through defining appropriate leadership roles for psychiatry at all levels of the system.

When CEO positions within public mental health programs are not held by psychiatrists, it is imperative that their clinical expertise be available in appropriately defined medical/clinical director roles at each level of the state system. Such senior clinical executives will be qualified psychiatrists who are knowledgeable by training and experience in contemporary treatment and rehabilitative modalities, clinical supervision, and administration. These positions will have authority to provide collegial oversight for all clinical services.

This document outlines a series of guidelines that delineate the roles of medical directors in state offices of mental health as well as in state and community mental health programs. With adequate support for medical director roles as defined by these guidelines, the quality of care within public systems will be improved.

The underlining is added to indicate the self-service of the guidelines that are being developed. The overriding theme is that we should have this power because we have always had this power. We insist that psychological issues are medical in nature because we are medical doctors – and for no other reason. This contention, despite the lack of evidence to the contrary persists that serious mental illness is in the medical domain. Why? Is there a shred of evidence that a medical degree is needed to deal with these issues. The only evidence is the self-serving one of the dispensation of toxic drugs. Even in this area, psychiatrist, by and large are less than competent. Most don’t even know that statistically, six or more medications taken at the same time projects a 100% potential for negative reaction. Neuroleptic ‘cocktails’ are the treatment of the day. The only ones who benefit are the psychiatrists and the drug companies.

What imperative of clinical expertise exists? Psychologists and social workers are far ahead in providing clinical services; psychiatrist provide only medication. They have little or no expertise in any clinical practice – as is indicated by their own language.

Ultimately, the aim of practice guidelines is to improve patient care. Although some have argued that no guidelines should be promulgated until “all the data are in,” this is not possible given the pressure of clinical and administrative decisions. Psychiatrists and those charged with the allocation of health care resources must try to make the best possible decisions based on currently available data. Guidelines should help practicing psychiatrists determine what is known today about how best to help their patients.

Until ‘all the data are in’ is code for the fact that psychiatry is essentially a technology without any scientific basis. In fact, all of the data collected so far is contrary to the way psychiatrists practice: drugs are toxic [look up Malignant Neuroleptic Syndrome] and not helpful [with the possible exception of bipolar]; there is no support for psychoanalysis that it is any more effective than time; electroconvulsive shock therapy is hardly acceptable. Is there any question as to why psychiatry is the only helping profession picketed by those is says it wants to help!

Here we are, after decades of psychiatric practice, and the American Psychiatric Association is just struggling to develop guidelines for practice and is unsure that they know what the hell they are doing! Gives you confidence, doesn’t it. And they want positions of authority over all clinical services. Well let’s not give it to them.

Psychiatrists are fighting for their lives; they are desperate. The original purpose of medical expertise was to rule out a medical cause for the psychological state. Despite the failure of psychoanalysis, it was an attempt to provide clinical input. “Every science has to pass through this ordeal by quackery, and at the present time psychology, on its way toward becoming a proper science, has to slough off the quackery of Freudianism. Psychoanalysis is a pseudoscience just as alchemy and astrology were pseudosciences [Popper, 1959], and while its influence prevails, it will prevent psychology from emerging from its chrysalis” Eysenck. But psychiatry has not moved away from psychoanalysis, See above concerning ‘Psychiatric Management’ and “supportive psychotherapy” and/or “insight-oriented psychotherapy”.

One of the more common illusions of Freudian orthodoxy is that the durability of results corresponds to the length of therapy” [Gutheil]. This, of course, helped to bring home the bacon for quite a while. By the way, does drug therapy ever end? Gee, this is kind of like residuals – once I prescribe, I continue to make money for a long time.

But the fact is that psychiatrists don’t even practice psychodynamic interventions any more, they simply tell other people to do it; and it doesn’t work. And we have known it doesn’t work from 1959 as stated above. In fact the only way of continuing this atrocious behavior in this time of scientific inquiry is to group this [psychodynamic] and that [cognitive/behavior interventions] and claim that it is the same thing.

By grouping cognitive and behavioral interventions as psychotherapies, psychotherapies show some success. Of course, cognitive and behavioral interventions are of an entirely different order than psychodynamic therapies and are based on social learning theory. In fact the interventions are not appropriately called treatment or therapies at all. The more appropriate terms would be teaching or training. Thus the helper or change worker trains the individual in skills that enables them to take responsibilities for their own lives.

Since psychiatrists generally believe that there is a pathology that is causing the behavior and that until a cure is achieved nothing will change, the inclusion of cognitive and behavioral interventions directly opposes their belief systems. Yet, cognitive behavioral ‘therapy’ is an accepted part of a process that is presumably improved by drug taking. Need I point out that taking drugs sends a message that is exactly opposite to the social learning expectation?

Which leads us, perhaps to the whole question of seeking and using help. First, another part of the psychiatric practice guidelines.

4. Enhancing treatment compliance

Bipolar disorder is a long-term illness in which adherence to carefully designed treatment plans can improve the patient’s health status. However, patients with this disorder are frequently ambivalent about treatment. This ambivalence often takes the form of noncompliance with medication and other treatments (24, 25). Noncompliance with mood-stabilizing medications is a major cause of relapse (26, 27).

Ambivalence about treatment stems from many factors. One is denial. Patients who do not believe that they have a serious illness are not likely to be willing to adhere to long-term treatment regimens. Patients with this disorder may minimize or deny the reality of a prior episode, their own behavior, and often the consequences of their behavior. Denial may be especially pronounced during a manic episode.

Another important factor for some patients is their reluctance to give up the experience of mania (24). The increased energy, euphoria, heightened self-esteem, and ability to focus may be very desirable and enjoyable. Patients often recall this experience and minimize or deny entirely the subsequent devastating features of full-blown mania or the extended demoralization of a depressive episode. They are therefore often reluctant to take medication that prevents mania.

Medication side effects and other demands of long-term treatment may be burdensome and need to be discussed realistically with the patient and family members. Many side effects can be corrected with careful attention to dosing, scheduling, and preparation. Troublesome side effects that remain must be discussed in the context of an informed assessment of the risks and benefits of the current treatment and its potential alternatives.

It is unfortunate, for me, that this particular guideline is about bipolar. I probably should have sought out another section, I am sure compliance is an issue all over the place. Resistance means that I don’t want your help, thank you. I resist when I think what you are asking is unhelpful. I am after all the sum total of what I think, and if I think this is unhelpful or harmful, I may not want to do it. And who are you to decide that it is for my own good?

The reason it is unfortunate for me, is that in my experience, the one place that people tell me that the medication is helpful, is in bipolar. And since I believe that people are autonomous agents, my only concern is that they have made an informed choice. And by the way, for bipolar, with all the facts, most people choose to take the drugs. And that is there right. However, the same is not true, in my experience, for any other mental status. Therefore, when I discuss this resistance or noncompliance, I am generally taking this from another perspective. Denial is an interesting term. I deny schizophrenia exists. And I defy any psychiatrist to demonstrate that it does [see paragraph by Seibert above]. Why should anyone who comes to the ‘doctor’ for help, continue to comply with a plan of care which makes them much worse, but which pleases the people around them. Medication side effects are more than burdensome, according to psychiatrist Peter Breggin.

Chapter 5: Neurotoxity of the Major Tranquilizers, from Peter Breggin’s book.

The major tranquilizers are highly toxic drugs; they are poisonous to various organs of the body. They are especially potent neurtoxins, and frequently produce permanent damage to the brain.

The liver is often adversely affected…develops jaundice without other severe symptoms.

A variety of blood disorders have been reported…. In rare cases, agranulocytosis [a decrease in certain white blood cells] renders the patient susceptible to life-threatening infection.

Many cardiovascular complications may develop, usually based on disturbance of the autonomic nervous system, including abnormalities of electrical conduction of the heart and various arrhythmias. …a drop in blood pressure.

…Patients complain of dry mouth, stuffy nose, blurred vision, urinary retention, constipation and impaction, and, in extreme cases, paralytic ileus [inhibition of the intestine]. In men ejaculation may be inhibited, or reversed into the bladder, in a painful manner. Glaucoma may be aggravated.

Endocrine disorders are not uncommon, including increased appetite and obesity, edema, breast engorgement in women, menstrual irregularities, gynecomastia [mammary growth in men], impotence in men, and hypersexuality in women.

Skin changes …including allergic reactions …photosensitivity to the sun…sometimes…a disfiguring gray-blue pigmentation of the skin,….

…Accumulation of opaque deposits in the lens and cornea of the eye.

…Suppressing perspiration,…….may also have suppressed the heat-regulating centers of the brain.

And by the way he didn’t even mention tardive dyskinesia, which took clients twenty years of court battles for the psychiatric community to even admit. This is an irreversible reaction that causes tics, quacks, and other body movement, which many people think is the ‘mental illness’. This is the palliative that psychiatry has to offer to its most profoundly affected clients.

But of course the medication isn’t curative. This is just a ‘quick fix’ to hold you until we find a cure – and that will occur right after we find the pathology.

Finally, we are finding more and more children in need of psychotropic medication. We are creating a generation of ‘junkies’ and we are paying the drug dealers an enormous amount of money in the process. With this note, I will leave off my diatribe against psychiatrist and provide you with one final quote that I found in I And You: A Prologue by Walter Kaufman

Mundus vult decipi: the world wants to be deceived. The truth is too complex and frightening; the taste for the truth is an acquired taste that few people acquire.

Not all deceptions are palatable. Untruths are too easy to come by, too quickly exploded, too cheap and ephemeral to give lasting comfort. Mundus vult decipi; but there is a hierarchy of deceptions.

On a higher level we find fictions that men eagerly believe, regardless of the evidence, because they gratify some wish.

Near the top of the ladder we encounter curious mixtures of untruth and truth that exert a lasting fascination on the intellectual community.

What cannot, on the face of it, be wholly true, although it is plain that there is some truth in it, evokes more discussion and dispute, divergent exegesis and attempts at emendations than what has been stated very carefully, without exaggeration or onesidedness.

Mundus vult decipi: The world winks at dishonesty. The world does not call it dishonesty.

Once a few respected men have fortified a brazen claim with their prestige, it becomes a cliché that gets repeated endlessly as if it were self-evident. Any protest is regarded as a heresy that shows how those who utter it do not belong: arguments are not met on their merits; instead one rehearses a few illustrious names and possible deigns to contrast them with some horrible examples.

These respected men, these psychiatrists, have betrayed our trust. How long will we wink at their dishonesty?