11/6/00, Fred A. Baughman Jr., MD: I cannot think of a stronger, more
accurate, analysis of biological psychiatry than this by David
Kaiser, MD, psychiatrist, humane physician. This cannot be said of any
psychiatrist who has deserted the ‘mind’of their patient, pretending to
diagnose and treat the brain, doing this for profitfor their own profit
as well as for that of their paymaster, the pharmaceutical industry. My
comments are inserted within Dr. Kaisers text in brackets [ ] .
The following article is by David Kaiser M. D.- who has written a number
of journal articles and is on the staff of Northwestern University Medical
School Hospital. http://myweb.rust.net/~norman/kaiser.html Date:
11/5/00 12:35:42 AM Pacific Standard Time
NOT BY CHEMICALS ALONE: A HARD LOOK AT "PSYCHIATRIC MEDICINE" BY DAVID KAISER M.D. As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journals is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.
thus my encountering not just parents, but grandparents as
welltwo generationsthat believe that the normal rambunctiousness of
their children and grand children are diseases, due a chemical
imbalances of the brain. No longer can they understand all that is the
trying, challenging normalcy of childhoodthings they themselves are
best-suited, with common sense and parental instinct to care for and
guide. Now they see such behaviors as diseases, as chemical
imbalances that need diagnosing by psychiatrists and other mental
health professionals, and that need, in virtually every case, chemical
balancerspills. No longer can they see all that is the width and
breadth of normal emotions and behavior in themselves, their families,
communities. They will have been deceived into believing that all of
this need, diagnosis, interpretation, management and treatment from
psychiatry and the mammoth, burgeoning mental health (teachers included)
The purpose of this piece is not to attempt a full critique or history of this occurrence, but merely to present some of the glaring problems of this movement, as I believe significant harm is being done to patients under the guise of modern psychiatric treatment. I am a psychiatrist trained in the late 1980s and early 1990s, and I use both psychotherapy and medication in my approach to patients. I state these facts to make it clear that this is not an anti-psychiatry tract, and I am speaking from within the field of psychiatry, although I find it increasingly impossible to identify with this profession, for reasons which will become clear below. Biologic psychiatrists as a whole are unapologetic in their view that they have found the road to truth, namely that mental illnesses for the most part are genetic in origin and should be treated with biologic manipulations, i.e., psychoactive medications, electroconvulsive treatment (which has made an astounding comeback) and in some cases psychosurgery.
they are unapologetic and dictatorial, but, one-on-one, are
easily challenged and intimidated. A young father asked his sons
psychiatrist: "Why the Ritalin?" The psychiatrist responded: "He has
ADHD, due to a chemical imbalance of the brain!" The young father then
asked: "Show me the lab work!" The psychiatrist hemmed and hawed,
because of course there was no lab work there never is, there is never a
test or proof of any kind (why I call ADHD, and all biological
psychiatry a total, 100% fraud). The young father persisted, saying, "I
want to see the results of any tests you have done." The psychiatrist,
grew flustered and finally lost it at which point he banished both
father and son from his office (there is never an examining room),
firing the boy as his patient. I am fond of saying that the "Is it a
diseaseyes or no?" questionif yes show me the lab work, the scan,
the biopsy report, the x-ray, is, to the biological psychiatrist, like
the crucifix to Count Dracula. Both are destroyed by the light of day.
Further, I can tell any lawyer, barrister, how to destroy any biological
psychiatrist with the light of day in any courtroom.]
Although they admit a role for environmental and social factors, these are usually relegated to a secondary status. Their unquestioning confidence in their biologic paradigms of mental illness is truly staggering. In my opinion, this modern version of the ideology of biologic/genetic determinism is a powerful force that demands a response. And when I use the word ideology here, I mean it in its most pernicious form, i.e., as a discourse and a practice of power whose true motivations and sources are hidden to the public and even to the practitioners themselves, and which causes real harm to the patients at the receiving end. Biologic psychiatry as it exists today is a dogma that urgently needs to be unmasked.
this is as accurate a description of biological psychiatry
as I have seen. Having said that, all that is biological psychiatry
must now be identified; fingered, exposed to the full light of day, in
all of the proper court rooms, especially in those courtrooms that order
parents, under threat of loss of custody, to consent to treat and
tothemselves actively participate in the treatment of their children
with powerful toxic chemicals for the diseases of biological psychiatry
that simply do not exist and, whats more, will never exist.]
One of the surest signs that dogmatists are at work here is that they rarely question or attempt to problematize their basic assumptions. In fact, they seem blissfully unaware that there is a problem here. They act in seeming unawareness that they are caught up in larger historical and cultural forces that underwrite their entire "scientific" edifice. These forces include the medicalization of all public discourse on how to live our lives, a growing cultural denial of psychic pain as inherent in living as human beings, the well-known American mixture of ahistoricism and belief in limitless scientific progress, and the growing power of the pharmaceutical and managed care industries.
It is mainly the growing, now-awsome power of the
pharmaceutical industry, and unlimited pharmaceutical dollars (drug
money) that permeate the US political process, that have brought us to
this point. Their acquisitionbuying of psychiatry (once a profession)
was accomplished without a whimper. Their acquisition of psychology and
all else that is mental health (an oxymoron) is largely complete as
The self-proclaimed visionaries, oblivious to all of this, boast of real scientific progress over what they consider to be the dogma of psychoanalysis, which had up until recently reigned as psychiatry's premier paradigm. Now, it is not my intention to defend psychoanalysis, which had its own unfortunate excesses, although I do use psychoanalytic principles in the kind of psychotherapy I do. However it is quite clear to me that the grandiose claims of biologic psychiatry are wildly overstated, unproven and essentially self-serving. Biologic psychiatry has had its successes, particularly with recent antidepressants like Prozac and newer medications such as Clozaril. Medications can effectively improve depression, relieve severe anxiety, stabilize serious mood-swings and lessen psychotic symptoms. These successes are real in that they improve the quality of life of patients who are genuinely suffering. But in reality, i.e., the reality of treating patients, medications have profound limitations. I know that if the only tool I had in treatment was a prescription pad, I would be a poor psychiatrist. The center of treatment will always need to be listening to and speaking with the patients coming to me. This means listening seriously to what they say about their lives and history as a whole, not symptoms which might respond to medications. Although it seems astounding that I would have to state this, biologic psychiatrists as a whole really only listen to that portion of the patient's discourse that corresponds to their biologic paradigms of mental illness.
As a neurologist my primary role for each new patient was to
determine, by history (subjective) and examination (objective), lab,
x-ray, scanning, etc. (objective) whether abnormalitydisease, was
present or not. About 2/3 or so of patients I saw had no disease but
had symptoms that were psychological, that is, emotional and
behavioral. Where these were not ingrained and deep-seeded, I would
venture brief treatment for them myself. A brief explanation of how,
having ruled out physical (organic) disease left the psychological
explanation, the only alternative, often went a long way toward
relieving the patients worries, putting them on a footing to adapt, to
pull themselves up by their bootstraps and to prevailgetting back to
normal. By the early 80s, psychiatrists had embraced the biological
model such that all almost every patient I referred to them got was a
pill--no talking too, no understanding of where from amongst their
lifes travails, their worrisome symptoms might be coming from. At that
time I stopped sending patients to them and began referring such
patients only to mental health providers without prescription pads.
They are much more difficult to avoid nowadays]
It is the nature of dogma that its practitioners hear only what they want to hear. So what are the limitations of biologic psychiatry? First of all, medications lessen symptoms, they do not treat mental illness per se. This distinction is crucial. Symptoms by definition are the surface presentation of a deeper process. This is self-evident. However, there has been a vast and largely unacknowledged effort on the part of modern (i.e., biologic) psychiatry to equate symptoms with mental illness. For example, the "illness" major depression is defined by its set of specific symptoms. The underlying "cause" is presumed to be a biologic/genetic disturbance, even though this has never been proven in the case of depression.
or in any psychiatric disorder/disease that is known. In not
a single one is there a confirmatory, objective finding, abnormality or
exam, lab, scan, biopsy, culture, anythingItbiological psychiatry is a
total fraud. ]
The errors in logic here are clear. A set of symptoms is given a name such as "major depression," which is then "treated" with a medication, despite the fact that the underlying cause of the symptoms remains completely unknown and essentially untreated. I have seen repeatedly that, for example, once medications lessen the symptoms, I am still sitting across from a suffering patient who wants to talk about his unhappiness. This process of equating symptoms with illnesses has been repeated with every diagnostic category, culminating in perhaps one of the greatest sophistries psychiatry has pulled off in its illustrious history of sophistries, namely the creation of the Diagnostic and Statistical Manual (currently in its fourth incarnation under the name DSM-IV), the bible of modern psychiatry. In it are listed all known "mental disorders," defined individually by their respective symptom lists. Thus mental illnesses are equated with symptoms. The surface is all there is. The perverse beauty of this scheme is that if you take away the patient's symptoms, the disorder is gone. For those who do serious work with patients, this manual is useless, because for me it is simply irrelevant what name you give to a particular set of symptoms. It is an absolute myth created by modern psychiatry that these "disorders" actually exist as discrete entities that have a cause and treatment. This is essentially a pseudo-scientific enterprise that grew out of modern psychiatry's desire to emulate modern medical science, despite the very real possibility that psychic pain, because of its existential nature, may always elude the capture of modern medical discourse and practice.
Fail to understand that biological psychiatry is an absolute
myth and you fail to understand biological psychiatry. ]
Despite its obvious limitations, the DSM-IV has become the basis for psychiatric training and research. Its proponents claim that it is a purely a phenomenological document stripped of judgments and prejudices about the causes of mental illness. What in fact it has done is the defining and shaping of a vast industry of research designed to validate the existing diagnostic categories and to find ways to lessen symptoms, which has basically meant biologic research. Virtually all of the major psychiatric journals are now about this, and as such I find them useless to help me deal with real patients.
I have begun to write an analysis of the fraudulence of all
biological psychiatry research. The duplicity is unimaginable and it
is just this that they count on. ]
Patients are suffering from far more than symptoms. Symptoms are the signs and clues to direct us to the real issues. If you take away the symptoms too quickly with medications or suggestion, you lose the opportunity to help a patient in a more profound way. As an aside, modern psychiatrists, because they have forgotten or dismissed the real power of transference, vastly underestimate the extent which symptom reduction is caused by mere suggestion. Not that patients should be left to suffer needlessly from what are often crippling symptoms. Relief of symptoms is a part of treatment. Modern psychiatry would have us believe that this is all treatment should be. Meaning, desire, loss and death are no longer the province of the psychiatrist. In this process patients are reduced to something less than fully human, as they become an abstract collection of symptoms without meaning to be "managed" by technicians called psychiatrists. This is in the service of medical progress and enlightened scientific thought. The biologic psychiatrist will not make the mistake of imposing their value systems on patients like in the bad old psychoanalytic days. This is, of course, a sham. Modern psychiatry now foists on patients the view that their deepest and most private ills are now medical problems to be managed by physician psychiatrists who will take their symptoms and return them to "normal functioning." This is a bit more than malignant. One of the dominant discourses that runs through the DSM-IV and modern psychiatry in general is the equating of mental health with "normal functioning" and adaptation. There is a barely concealed strain of a specific form of Utopianism here which blithely announces that our psychic ills are primarily biologic and can be removed from our lives without difficulty, leaving us better adapted and more productive. What is left completely out, of course, are any notions that our psychic ills are a reflection of cultural pathology. In fact, this new biologic psychiatry can only exist to the extent it can deny not only the truths of psychoanalysis, but also the truths of any serious cultural criticism.
leaving such problems un-addressed, in fact, denying that
they exist as they insert biologic defects of the brains hard-wiring
and of genes (such as the DNA Roulette of Harold Koplewicz of NYU, my
alma mater), they give patients pills and pills-alone leading to an
end-result that invariably equates to net damage for every patients
encounter with psychiatry.]
It is then no surprise that this psychiatry thrives in this country presently,where such denials are rampant and deeply embedded. I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. However, this does not stop psychiatry from making essentially unproven claims that depression, bipolar illness, anxiety disorders, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin, and that it is only a matter of time until all of this is proven. This kind of faith in science and progress is staggering, not to mention naïve and perhaps delusional.. As in any dogma there is no perspective within biologic psychiatry that can effectively question its own motives, basic beliefs and potential blind spots. And thus, as in any dogma, there is no way for the field to curb its own excesses, or to see how it might be acting out certain specific cultural fantasies and wishes. The rise and fall of biologic determinism in a culture likely has complicated and interesting causes, which are beyond the scope of this paper. A few comments will have to suffice. This is a culture increasingly obsessed with medical science and medical health as a sign of virtue. It is not surprising that our psychic ills would be pulled into this dominant medical discourse, essentially medicalizing our specific forms of psychic pain. It seems to me that modern psychiatry in step with a culture which created it, assumes any suffering to be unequivocally bad, an impediment to the "good life" of progress, productivity and progress. It is now almost heresy in psychiatry to say that perhaps suffering can teach us something, deepen our experience, or point us to different possibilities. Now if you are depressed or anxious, it has no real meaning, because as a biologic illness similar to, say, diabetes, it is separate from the world of meaning and merely is. Now any thoughtful person knows that something as fundamental as depression has meanings such as loss, facing mortality, unlived desires. lack of power or control, etc., and that these meanings will continue to exist even if Prozac makes us feel better. There is much more to life than feeling better or living without pain, and only a superficial and pathologic culture would deny this. Yet conclusions such as "depression is a chemical imbalance" are created out of nothing more than semantics and the wishful thinking of scientist/psychiatrists and a public who will believe anything now that has the stamp of approval of medical science. It seems to me that modern psychiatry is acting out a cultural fantasy having to do with the wish for an omniscient authority who armed with modern science, will magically take away the suffering and pain inherent in existing as human beings, and that rather than refusing this projection (which psychoanalysts were better able to do), modern psychiatry has embraced the role wholeheartedly, reveling in its new-found power and cultural legitimacy. I would be remiss if I left out the obvious economic factors in psychiatry's movement toward the biologic. Pharmaceutical corporations now contribute heavily to psychiatric research and are increasingly present and a part of psychiatric academic conferences. There has been little resistance in the field to this, with the exception of occasional token protest, despite its obvious corrosive and corrupting effects. It is as if psychiatry, long marginalized by science and the rest of medicine because of its "soft" quality, is now rejoicing in its new-found legitimacy, and thus does not have the will to resist its own degradation. The fact that the drug companies embrace and fund this New Psychiatry is cause enough for alarm. Equally telling is a similar embrace by the managed care industry, which obviously likes its quick-fix approach and simplistic approach to complicated clinical problems. When I talk to a managed care representative about the care of one of my patients, they invariably want to know what medications I am using and little else, and there is often an implication that I am not medicating aggressively enough. There is now a growing cottage industry within psychiatry in advocating ways to work with managed care, despite the obvious fact that managed care has little interest in quality care and realistic treatment approaches to real patients. This financial pressure by managed care contributes added pressure for psychiatry to go down a biologic road and to avoid more realistic treatment approaches. What this means in real terms is that psychotherapy is left out. There has been a triple partnership created between this New Psychiatry, drug companies and managed care, each part supporting and reinforcing the other in the pursuit of profits and legitimacy. What this means to the patients caught in this squeeze is that they are increasingly overmedicated, denied access to psychotherapy and diagnosed with fictitious disorders, leaving them probably worse off in the long run.
I do not think managed cares dalliance with the pill model
of psychiatry will last or that it is so different in managed care than
in what remains of fee-for-service mental health. Given nothing but a
pill, patients are not better off for long, nor do they have an illusion
of being better off for long (as long as it takes for placebo effect to
wear off) . Come the time that the vast majority come back to managed
cares door, not better off but worse, managed care will take note and
will adjust and will find what it takes to get people symptom free and
staying that way, not forever at their door]
It is quite depressing to listen to the discourse of modern psychiatry. In fact, it has become embarrassing to me. One gets the strong impression that patients have become abstractions, black boxes of biologic symptoms, disconnected from the narratives of their current and past lives. This pseudoscientific discourse is shot through with insecurity and pretense, creating the illusion of objectivity, an inevitable march of progress beyond the hopeless subjectivity of psychoanalysis. Psychotherapy is dismissed and relegated to non-medical therapists. I actually have no objections to real science in the field, if, for example,it can help me make better medication decisions or develop newer and better medications. But in general, biologic psychiatry has not delivered on its grandiose and utopian claims, as today's collection of medications are woefully inadequate to address the complicated clinical issues that come before me every day. This is all not terribly surprising, given what I have outlined in this piece. There will be no substitute for the difficult work of engaging with patients at the level of their lived experience, of helping patients piece together meaning and understanding in the place of their pain,fragmentation and confusion. Patients these days are not suffering from "biologic illnesses." What I generally see is patients suffering from current or past violence, traumatic loss, loss of power or control over their lives and the effects of cultural fragmentation, isolation and impoverishment that are specific to this culture at this time. How this manifests in any individual is absolutely specific; therefore, one should resist any attempt to generalize or classify, as science forces us to do. Once you go down the route of generalization, you have ceased listening to the patient and the richness of their lived experience. Unfortunately what I also see these days are the casualties off this new biologic psychiatry, as patients often come to me with many years of past treatment. Patients having been diagnosed with "chemical imbalances" despite the fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like. Patients with years of medication trials which have done nothing except to reify in them an identity as a chronic patient with a bad brain. This identification as a biologically impaired patient is one of the most destructive effects of biologic psychiatry. Modern psychiatrists seem unaware of what psychoanalysts know well, namely how powerful are the words that a patient hears from an authority figure like a psychiatrist. The opportunity here for suggestion, coercion and manipulation are quite real. Patients are often looking to psychiatrists for answers and definitions as they struggle with questions such as who am I, or what is happening to me. Of course we all struggle with these questions, and the human condition is such that there are no definitive answers, and anyone who comes along claiming they have answers is essentially a fraud. Biologic psychiatry promises easy answers to a public hungry for them. To give a patient nothing but a diagnosis and a pill demonstrates arrogance, laziness and bad faith on the part of the psychiatrist. Any psychiatrist needs to be continually aware of the very real possibility that they are or can easily become agents of social control and coercion.
they are becoming this at a very rapid rate and they revel in
the power and in their allegiance both with political might and
monetarycorporate might ]
The way to resist this is to refuse to take on the role assigned through cultural fantasy, namely the role of omniscient dispenser of magical potions. As a whole, modern biologic psychiatry has enacted this role with particular vigor and enthusiasm. At the level of individual patients this means a growing number of over-diagnosed, over-medicated and disarticulated people less able to define and control their own identities and lives.
As a medical-therapeutic pretense the net outcome is
invariably negative. In sum, this is a monstrous crime]
At the level of our culture this has meant an impoverishment of the discourse around such questions as what is wrong with us, as "scientific" answers replace more potentially fruitful and truthful psychological and cultural questioning. If psychiatry is to regain any semblance of legitimacy and integrity, it must strip itself of false and hubristic scientific claims and humbly submit itself to the urgent task of listening to individual patients with patience and intelligence. Only then can we have any real sense of what to say back to them. The sole philosophic basis for this New Psychiatry is the championing of empiricism above all other measures of truth. Something is valid only if it can be demonstrated through the experimental method, otherwise it is disregarded or relegated to "subjective" experience, which is presumed to be inferior. This dominance of empiricism is not limited to psychiatry, and one can easily trace the invasion of the "hard" sciences into the "soft' or social studies. On a larger cultural level this can be detected in the public's infatuation with "studies," statistics and so on. This hegemony of empiricism over other ways of thinking and knowing represents an unprecedented modern achievement that has thoroughly infiltrated the cultural psyche, to the point now where the average person believes easily the claims of the biologic psychiatrist. Now, as is clear from my views already expressed, a social science dominated by empiricism is a vulgar science, and there is a vast tradition in philosophy from Plato to Nietzsche, which in my view irrefutably demonstrates this. However, this is well beyond the scope of this piece. Suffice it to say that modern psychiatrists, like all "scientists" these days, have not time for the basic philosophic questions that have engaged the most brilliant minds of the past. Who needs questions about virtue when there is important data to collect? These biologic psychiatrists never think to ask themselves whether their own precious methods are perhaps standing on very shaky ground, e.g., their own disavowed prejudices about what constitutes the good life. Empiricism is one way of knowing, but certainly not the only or best way. Biologic psychiatrists often use the standards of empiricism to answer their critics, in effect saying that their claims are scientifically "proven" and thus unassailable, clearly a tautological argument. I would further add that that in my view many of the claims of biologic psychiatry do not even hold up to their own standards of empiric science, for example their claims about the biological and genetic bases of many mental illnesses. In my view, the methods of experimental science are inappropriate and misplaced when it comes to understanding the complexity of the human psyche, as they can only objectify the mind and remove subjectivity from the heart of human experience, thus creating an abstract entity in place of a human mind. It is no wonder that psychiatry declared the 1990s the decade of the brain instead of the decade of the mind. In their pursuit of the human brain, they have quite literally lost their minds. One way to unmask the dogma that is biologic psychiatry is to ask the question what kind of human being is being posited as desirable, "normal," or not disordered. Judging by the DSM-IV, it would be a person not depressed or anxious, without perversions or sexual "dysfunction," in touch with "reality," not alienated from society, adapted to their work, not prone to excessive feeling states and generally productive in their life pursuits. This is, of course, the bourgeois ideal of modern culture. We will all fit in, produce and consume and be happy about it. Anyone who dissents by choice or nature slips into the realm of the disordered or pathologic, is then located as such by medical science and is then subject to social management and control. Now psychiatry has always provided this social function, as admirably shown by Foucalt and others. I would submit, however, that modern psychiatry, under the guise of medical and "scientific" authority and legitimacy, has surpassed all past attempts by psychiatry to identify and control dissent and individual difference. It has done this by infiltrating the cultural psyche, a psyche already vulnerable to any kind of medical discourse, to the point where it is a generally accepted cultural notion now that, say, depression is an illness caused by a chemical imbalance. Now when a person becomes depressed, for example, they are less able to read it or interpret it as a sign that there may be a problem in their life that needs to be looked at or addressed. They are less able to fashion their own personal or cultural critique which could potentially lead them to more fruitful directions. Instead they identify themselves as ill and submit to the correction of a psychiatrist, who promises to take away the depression so they can get back to their lives as they are. In short, the very meanings of unhappiness are being redefined as illness. In my view this is a dismaying cultural catastrophe. I do not mean to suggest that psychiatry is solely to blame for this, given how wide a cultural shift this is. However, I do think that psychiatry has not only not resisted its role here, but actually has fulfilled it with considerable hubris. Thus, in my view the whole phenomenon of biologic psychiatry is itself a symptom or acting out of a larger, underlying cultural process. Unhappiness and suffering are not seen as resulting from real cultural conditions; for example, the collapse of traditional institutions and the ever-increasing hegemony of rampant consumerism in American culture. Nor is suffering seen in the context of what it means to exist as a human being in any historical period. Historical and existential discourse about unhappiness is increasingly supplanted by medical discourse, and biologic psychiatry has served as one of the major mouthpieces for this kind of pseudoscientific and frankly pathetic medical discourse about what ails us. I am increasingly astonished about how unable the average patient is now to articulate reasons for their unhappiness, and how readily they will accept a "medical" diagnosis and solution if given one by a narrow-minded psychiatrist. This is a cultural pathologic dependence on medical authority. Granted, there are patients who do fight this kind of definition and continue to search for better explanations for themselves which are less infantalizing, but in my experience this is not common. There is a frightening choking off of the possibility for dissent and creative questioning here, a silencing of very basic questions such as "what is this pain?" or "what is my purpose?" Modern psychiatry has unconscionably participated in this pathology for its own gain and power. It is a moral, not scientific issue at stake here, and in my view this is why many astute Americans rightfully distrust this New Psychiatry and its utopian claims about happiness through medical progress. So what kind of psychiatry am I advocating here? First of all, I think it is unclear whether the field can extricate itself from its current infatuation with technology and its own power to use it. When one reads psychiatric journals now, one senses a dangerous giddiness about the field's "discoveries" and "progress," which in my view are wildly and irresponsibly overstated. All the momentum, which is mainly economically driven, is pushing psychiatry towards further biologism. What I am advocating is a psychiatry which devotes itself humbly to the task of listening to patients in a way that other medical practitioners cannot.
and the way psychiatry still did in the 60s and 70s. I
shared an office at this time, in Grand Rapids, Michigan with a humane,
caring psychiatrist. He made no pretense that he diagnosed and treated
brain diseases as is the claim, uniformly, today.]
This means paying close attention to a patient's current and past narrative without attempting to control, manipulate or define it. From this position a psychiatrist can then assist the patient in raising relevant questions about their lives and pain. The temptation to provide answers or false solutions should be absolutely avoided here. Medications are used judiciously for lowering painful symptoms, with considerable attention paid to the psychological effects of medication treatment. Diagnosis should play a secondary and small role here, given that little is known about what these diagnoses actually mean. Above all, coercion, normalization and control need to be assiduously guarded against, as these are natural temptations that arise out of the dynamics of power that exist between psychiatrist and patient.
all on the mental health team--teachers, all school
personnel, counselors, social workers, psychologists, local police,
pediatricians, general and family practitioners, neurologists, child
neurologists, adult and child/adolescent psychiatrists, have succumbed
to the power trip of brain diagnosis and of not only pontificating
about the brain of another, but taking charge of it, the child, the
family, by calling in the police and courts to enforce their mutual
diagnoses and their prescriptionsand no just their IEPstheir
Individualized Educational Prescription, nothing but another empty
pretense to being medical practitioners.]
A more humane psychiatry, if it is even possible in today's cultural climate, must recognize the powerful potential of the uses and abuses of power if it is not to become a tool of social control and normalization. As I have outlined in this piece, these abuses of power are by no means always obvious and self-evident, and their recognition requires rigorous thought and self-examination. The psychiatrist plays a particular role in cultural and individual fantasies, and an intelligent psychiatrist must be aware of the complexity of these fantasies if he is to act in a position outside these projections and fantasies. This requires real moral awareness on the part of a psychiatrist who wishes to act intelligently. What I am advocating for in outline form as stated previously are the minimal requirements necessary for the field of psychiatry to reverse its current degradation. What is essential at this time is for psychiatrists and other clinicians to speak out against the ideology known as biologic psychiatry.
US biological psychiatry has positioned itself , regarding
monetary and political power, exactly where the biological psychiatry
of Nazi Germany had positioned itself prior to and in the early,
pre-holocaust months of WWII. Biological psychiatry today, with all of
the involuntary control it seeks in forcing its treatments upon us, is
the biggest threat to the American, democratic way of life to appear in
our midst since the creation of the Union. Psychiatrists, even
biological psychiatrists all went to medical school and all know the
difference between having disease (abnormal) and not having disease
(normal). They all know in making their disease, chemical imbalance
pronouncements that they have adduced a diagnostic abnormality, that
they have not proven the presence of disease. For them to say so to the
patient or parents of a child, nonetheless is a knowing violation of the
right to informed consent and is tantamount to medical malpractice.]