On June 6, I wrote a post titled Psychiatry DID Promote the Chemical Imbalance Theory. The post generated a number of comments, five of which were from TherapyFirst, who in his first comment identified himself as Joel Hassman, MD, a practicing psychiatrist.
Dr. Hassman did not argue with the general notion that psychiatric practice today consists almost exclusively of the prescription of drugs. Indeed, in one of his own blog posts on June 16, 2013, he wrote in an open letter to newly qualified psychiatrists:
” . . . you are now agreeing to basically just prescribe medication and give limited, selective diagnoses that serve insurer and/or bureaucratic agendas first and foremost.”
” . . . your interest will be narrowly directed to prescribing more likely multiple medications from moment one of meeting the patient . . . “
And this general position – that psychiatry consists essentially of prescribing drugs – continues to be evident in his comments on the MIA post.
But then he introduces a twist that I haven’t encountered before – he blames the clients for what he aptly calls the “chemicalization” of mental health. Here are some quotes:
“Everyone rails about psychiatrists and other prescribers just dumbing down mental health care complaints to writing scripts, but, in the last 10 years or so, people come into treatment venues just wanting drugs, and dismiss any other intervention for care, irregardless of how appropriate and indicated as a standard of care such a treatment is warranted.”
“Seems to me it fits the antipsychiatry narrative at the end of the day. It is easier to crucify the doctors, harder to attack the general public who are reinforcing ‘better living through chemistry’, eh?”
“Sorry, but if there is going to be a valid and honest discussion/debate about who is at fault in the ‘chemicalization’ of mental health, don’t just pick on the doctors. Patients are pervasively demanding drugs, often ones of abuse potential of late, and have little to no interest in problem solving nor wanting to implement real and effective change for the better.”
“…where are the muzzle prints on these ‘victims’ foreheads that demand they take medication?”
“…you as a patient come to someone with an expertise and then have the gall to argue and demand interventions that do not fit as treatment A for the problem in front of the clinician, and I am to refer to him/her as ‘victim’?? Get real!”
As I noted earlier, this is an unusual and complicated perspective. On the one hand, there’s an element of truth in Dr. Hassman’s position. A great many people do indeed go to psychiatrists for the specific purpose of obtaining a prescription. And I think we can believe Dr. Hassman’s assertion that some of these individuals may become impatient and dismissive, and perhaps even demanding, when invited to explore other options.
But on the other hand, drug prescriptions are psychiatry’s stock in trade. It’s what the vast majority of psychiatrists offer, and what their customers have, reasonably and legitimately, come to expect. I have even heard numerous reports from clients that they were pressured by psychiatrists into taking pills.
I’m old enough to remember a time when outpatient psychiatry was almost entirely a talking and listening profession. Depression was considered a fairly ordinary and understandable phenomenon – part of the human lot, so to speak – and remediation was conceptualized as being largely a matter of seeking support and solace from friends and loved ones, and of making positive changes in one’s circumstances and lifestyle. In extreme cases, people did consult psychiatrists, but the purpose of these visits was to discuss issues and problems – not to obtain drugs.
I imagine that psychiatrists in those days felt that their years of medical training were somewhat wasted. The problems that they were helping people address were not considered medical in nature, except perhaps in very extreme cases, and there was nothing particularly medical about the “treatments.” And, of course, there were fewer psychiatrists.
Obviously things are very different today, and I think the fundamental questions here are: how did these changes come about? and, who’s to blame?
There is an obvious parallel between the growth of psychiatric prescribing and the growth of the illegal drug trade over the past fifty or sixty years. It is also obvious, and generally accepted, that the illegal trade is driven by demand, and would collapse overnight if that demand were to dry up.
So the question arises: is what Dr. Hassman calls the chemicalization of psychiatry essentially a product of consumer demand for drugs? And, of course, the answer, at least to some extent, is yes. If people stopped going to psychiatrists for prescriptions, then psychiatrists would have to either disband as a profession or find something else to do.
But there is another side to this coin. People who deal in illegal drugs make no pretense that their products are medications. For psychiatrists, however, this is their primary marketing tool. For decades, they and their pharmaceutical allies have promoted this fiction using every means at their disposal. Very few psychiatrists have distanced themselves to a significant degree from this position.
They have spread the seductive deception that virtually all significant problems of thinking, feeling, and/or behaving are caused by neurochemical imbalances which can be corrected only by ingesting their products. They have issued, and continue to issue, dire warnings as to the consequences of not taking these pills. They have persuaded parents that their children’s brains are impaired, and that even toddlers need to take the pills. And so on. The whole sordid tale has been exposed many times, but psychiatry, without a hint of shame or compunction, continues to spread this self-serving and destructive deception. In fact, at the present time, psychiatry, as represented by the World Psychiatric Association and the American Psychiatric Association, is actively working to improve its tarnished image with a view to expanding its market even further.
So, Dr. Hassman is probably correct when he writes that some clients do come to psychiatrists to obtain drugs, and are resistant to alternative suggestions. But I think there’s a bigger issue:
A steady stream of individuals, of all ages and from all walks of life, coming to psychiatrists for drugs is precisely the objective towards which the psychiatric leadership and vast majority of the rank and file have worked diligently for the past fifty years.
It wasn’t the customers who invented and disseminated the term “a chemical imbalance, just like diabetes.” And, it wasn’t the customers who wrote and expanded the DSM to provide an impression of legitimacy for the drug-pushing activity. That was psychiatry!
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This blog first appeared on Philip Hickey’s website
Behaviorism and Mental Health