Towards a Hermeneutic Shift in Psychiatry

Pat

You say: “… I believe that psychiatry has a future.” This may be more wishful thinking on your part than any type of firm belief based on historical necessity.

I know it may be hard to imagine letting go of one’s professional identity, especially when so much personal ego, work, emotion, and economic stability is dependent on it. Please step back for a moment and take an objective look at what your profession has become and how much harm is being perpetrated by a sizeable percentage of those practicing it.

Psychiatry at this point in history cannot be reformed or reworked in any way, shape or fashion to make it somehow useful to humanity in the long term. No kind of seismic shift, Ted William’s shift, or Hermeneutic shift can save it.

To focus people on trying to salvage psychiatry at this moment in history is like asking people stuck in a burning building to stop and take some time to study the science of fire fighting before attempting to leave the building.

With phrases such as: “…these approaches are simply inadequate…” it is clear that the essential message of this blog does not even approach grasping the gravity of the current crisis facing those people being harmed (and destined to be harmed) by the current paradigm of mental health “treatment.”

Human psychological distress and out of the norm thoughts and behaviors are not “illnesses” and cannot be understood or helped with this kind of understanding. When you say “… and the specialized insights given to us in medical training…” what do you possibly mean here as it relates to helping people in a psychological crisis? This line of thinking still seems to have one foot firmly stuck in the oppressive medical model.

Pat, I appreciate you and the critical psychiatry movement, but I don’t believe (given the current crisis that exists) that the main efforts of critical or dissident psychiatrists should be directed towards finding a way to salvage the profession by turning back the clock to a time when psychiatry was more focused on doing therapy than genetics, brain diseases, and psychopharmacology.

As a working therapist in the community mental heath system, I am also hopeful that the role of therapy and therapists will very soon leave history’s stage as well.

Yes, psychiatry may have a BRIEF future ahead (hopefully only measured by several decades) and there is some VERY POSITIVE WORK that dissident professionals could be doing in the coming period of time. For example:

1) Study the science of psychiatric drug withdrawal and open clinics and/or private practices (working with knowledgeable survivors) that are focused on helping people with withdrawal problems and ways to minimize dependency on psychiatric drugs.

2) Develop organized resistance and disruption of “business as usual” within all mainstream psychiatric organizations.

3) Join with psychiatric survivors and other dissidents in the mental health system in various forms of direct action and educational actions targeting all aspects of Biological Psychiatry within our society.

In the course of future battles ahead (which ultimately involves challenging the capitalist system itself from which Biological Psychiatry is now inseparable) there will evolve new ways to evaluate the role of current professional entities in the so-called “helping professions” to determine what will be useful for humanity going forward. We all have to dare to perhaps give up something to make this world a better place. “Dare to struggle, Dare to win.”

Richard

Hi Dr. Bracken,

I see how your discussion of the limits of the medical model draws from the understanding of the fatal limitations of methodological indivdiualism in reductionistic, psychological understanding. Very few behavioral healthcare workers doubt that their services provide the potentially comprehensive response to the expertly identified “mental illness”, whichever nonentity it is that plays the leading role in the patient’s life. They will likely believe that there are hitches and glitches and imperfections, but not something vastly wrong in the academic and professional world that guarantees a climate for producing error, sweeping in currents that flow as often top-down as bottom-up, always creating the greatest of opportunities for ignoring those errors.

Such as in diagnosis. You can’t get a doctor to take his nose off the label on a page, not that I’ve met. You can’t find anyone at all who reacts intellibly to a discussion of the problem of isolating the social existence within the skull of a single individual, if that’s most convenient to do, since that’s where the mental illness is. No one where I live who works and earns their living in behavioral healthcare will have heard of the well-known problems of methodological individualism, and I’ve never met one inside who had lately tried to make sense of Wittgentstein or Merleau-Ponty. They would also not be fast to relate to the idea that psychology can’t offer stand-alone scientific conclusions of human potential and suffering, or simply of human behavior. They don’t see why not.

As fast as you can believe, my efforts aim to seeing that none of my children’s children believe in mainstream acounts of behavioral problems or that its clientele’s best interests are the first order of business for clinicians. Non-patient-advocacy is the universal default position.

Thank you for this article reminding psychiatrists that each of us has a story. Although we are made of cells, we are complex beings, each with a rich history of relationships and life experiences, which often include sadness, trauma and joy. Compassionate, supportive relationships can help heal both our neurochemistry and our souls, without the neurotoxic side effects of psychiatric medications.

Dr. Bracken,

Welcome.

As a psychiatric survivor who is now thankfully more than a quarter-century free from psychiatry and its ‘meds’ — and who is also minimally familiar with your work as a psychiatrist (that is, I have exposure to various selections of your writings and talks online), I say without hesitance, thank you for your work’s message, I am truly glad to see you posting on this website.

Though I wish you’d keep the terms “mental illness” and “patient” sandwiched in quotation marks, what you offer here, in your first posting, is positively meaningful (and is, I believe, fairly representative of the over message in your work). It’s a good sample of your professional wisdom overall.

But, regarding your suggestion, that what you’re describing could somehow become the (really, incredibly bright) dawn of a new chapter in psychiatry, well, I feel certain you are expressing an impossible dream.

Psychiatry cannot be what you want it to be, Dr Bracken, because most psychiatrists (unlike you) haven’t got the capacity to work in the way you’re describing. Most haven’t the self-awareness or the disposition, so they will never be even minimally what you hope they will be.

And, the profession of psychiatry, as a whole, is just too far gone, down the road of ‘brain worship’ (thus, psychopharmacology-worship… and, for some psychiatrists, ECT worship) already; its practitioners have become (almost without exception) individuals who have no measurable interest practicing anything like the hermeneutics that you’re suggesting — nor anything even remotely comparable.

Psychiatrists are not often also liberal arts majors, Dr Bracken; they’re not lovers of great works of art, in the way you may be (some may collect art, I knew one who did, but he did not appreciate artists in the sense that your are describing); they are mainly folk who are awed by the latest brain science and by the now-standard, digitized color images that are created by brain-scan machines, fMRIs.

So, what you’re offering, in your encouragements (toward a world of psychiatry that would embrace hermeneutics), is really quite overly-optimistic, I think; it’s your dream/vision of what, I suppose, plenty of psychiatrists could ideally be in some alternate universe.

They’d be medical specialists who are adept at understanding the products of our life as would a great art historian understand Picasso’s most celebrated paintings! Wonderful…; but remember: in this universe, psychiatrists are (most of them) working directly or indirectly for governments — indeed, for government agencies that are unsurpassed by any other government agencies in their tendency toward bureaucracy.

In fact, these are agencies guided by laws, which are designed to control individuals’ thoughts, feelings and behaviors… at the expense of sacrificing their civil liberties.

Psychiatry is, above all else, a key System of Control, in modern/industrialized/secular societies; and, thus, rarely ever do any psychiatrists work entirely on behalf of their “patients” (they can’t).

Always, psychiatrists are beholden to the dictates of the System of Control, which guides their practices — which means there’s a constant threat of forced ‘treatment’ behind even their kindest offerings.

The psychiatric “patient” must ultimately bow down to the dictates of a State, which fears ‘deviance’ above all else, and it will always be psychiatrists, first and foremost, who will make sure that every “patient” in the ‘care’ of psychiatry does so…

To be marked as a psychiatric “patient” is almost always to be viewed (especially, by strangers) as potentially threatening, by society. Thus, no psychiatric “patient” can speak entirely freely about being a psychiatric “patient” …and their lives will inevitably be largely a mystery to their psychiatrists, as the “patient” who somehow ultimately ‘fails’ to ‘properly’ (in the eyes of psychiatry) present a current image of himself/herself that conforms and abides with the psychiatrists’ sense of propriety, will be subject to medical incarceration and forced or coerced brain treatments.

The “patient” of psychiatry must largely remain in hiding, as compared to others, who are not “patients” of psychiatry… because always are ways of being shafted by society, when one is known as a “patient” of psychiatry; and, there’s some implied coercion, in the psychiatrists’ officially prescribed recommendations, always.

This is all to say, in most instances, “patients” of psychiatry will not be fully known or understood by anyone — least of all their psychiatrists.

The stigma of being a “patient” of psychiatry is crippling in a way that most psychiatrists cannot admit to themselves; and, then there’s the stigma of psychiatric labeling…

Dr Bracken, few psychiatrists can or will ever feel free to fully enter the ‘world’ of their “patients” — especially, not those who are called “seriously mentally ill.”

Most psychiatrist fear that world terribly.

The psychiatrist is not a shaman, after all; s/he has not been ‘initiated’ into — has no knowledge of — the ‘underworld’ …that’s so well known by so many “chronic patients” of psychiatry; the shaman (i.e., real shaman) knows how to transcend that realm, overcoming any tendency toward living a life of persisting fears and anxiety, because s/he has face and overcome fear-of-death itself.

I’m not sure if you can understand the importance of that (probably, you can, but most psychiatrists can’t); most people who can appreciate what I am saying here will know what I mean, as I say: Psychiatrists are mainly bound to be and remain forever inept, at their work, with so-called “psychotic” people… because they have no first-hand, lived experience, no first-hand knowledge, of how to transcend ‘psychosis’ without resort to psychopharmacology.

And, consider this: The practice of shamanism (which, in modern times, has largely been replaced by psychiatry) was never traditionally a full-time job. The shaman was only a part-time shaman (traditionally); s/he was also a hunter and/or a gatherer — as well as, unusually, an artisan.

The psychiatrist, of course, is forever dependent upon being a psychiatrist (which typically requires pedaling emotionally and mentally suppressive drugs) to earn a living; and, in all eras and places where psychiatrists have put up a shingle, to earn a living, while they have worked full-time doing so, at most, only partially have they worked for the good of their “patients”; for, they are working to support themselves and their own families firstly, and, then, secondarily, they work for their society and for the families of “patients” who wish for nothing more or less than seeing the so-called “mental illness” of the identified “patient” controlled — which means the “patient” must be subdued — most often, chemically (if not by electric shocks).

(The “patient” of psychiatry is to be made subservient, to one and all; she is not to be encouraged to live a life of full self-expression, as did Picasso! Goodness, no…)

So, society allows the psychiatrist to earn his/her living by scheduling periodic fifteen minute sessions, to consult with “patients” on “medication” effects and so-called “side-effects” …adjusting ‘meds’ …as the “patient” slowly succumbs to “medication” induces metabolic disease and brain-shrinkage; and, that is it.

(I know that describes psychiatric practices here in the U.S. more than anywhere else, including where you live, but…)

Frankly, precisely because psychiatry has hit such lows here in this country, it is very easy to shun psychiatry altogether.

So, instead of psychiatry, I suggest the Ways of shamanism and Buddhism and yoga — all without government involvements. (Other psychiatric survivors have come to appreciate religious faiths and spiritual traditions, that work well for them…)

And, yes, that Way of yours (the hermeneutics that you describe) sounds perfectly good, too; however, much as I can and do appreciate the vision for psychiatry that you’re aiming to encourage, there’s just no way that it will happen on any considerable scale, because psychiatry has always been more or less obsessed with materialist-reductionist theories and labels (called “diagnoses”), and those theories and labels work best for the government control systems.

I assure you, no society can train professionals to appreciate human life and culture as you appreciate them; and, without a doubt, psychiatry will never adopt a great Way for knowing and appreciating the lives of “patients” in the way that you do…

Sorry to bust your bubble.

Respectfully,

Jonah

___________

P.S. — Much as I appreciate its over all message, I think your post fails to convey the reductionism that’s inherent in psychiatric labels. So, here’s a blog post that I recommend: http://mbramham.blogspot.com/2012/02/people-not-labels-or-categories.html

Now whether it is coming from the orthodoxy, or from the critics, I have a few problems with these types of arguments, chiefly because I think they serve as a way of ignoring the elephant in the room. The elephant I am speaking of is coercive practices. Certainly biologically reductive explanations conflict with explanations involving a social context. I just don’t think Hermeneutic explanations necessarily spare a person the sort of social condemnation you can get in both cases. The problem is not just that psychiatry in some cases doesn’t grasp that things happen within a social context. The problem is that, given psychiatry’s cozy little relationship with law, that context usually involves abduction, assault, torture, imprisonment and poisoning. You change that context, and you’ve done a great deal of good. A person can’t succeed once put on a one-way track to the garbage bin without an abrupt change in direction. It is the fact that you psychiatrists have to act as thought police and behavior cops that is the real problem. Thought crimes are not crimes, and ditto eccentricity and unorthodox behaviors. I’m still waiting for psychiatrists to recognize there is something wrong with depriving people of their human rights. If you are saying assault masquerading as medical treatment has a future, that’s a sad future, and I hope we can find plenty of people to oppose it.

Pat, Obviously psychiatry which is inherently coercive in any possible incarnation is absolutely hazardous to anyones health including you as a practitioner. We need you, all pseudo science aside ,to stop hiding what you don’t know behind terminology’s in an attempt to maintain the coercive authority of a basically Spanish Inquisitional type of criminal plague over humanity. Reinvent yourself find another title maybe Mr. and work for the advancement of people oppressed by psychiatry . Get some education on how not to harm your fellow human being . Yes it takes courage. Fred

I respectfully disagree. I would like to see psychiatry abolished as a profession. If I thought I had a problem with my brain, I’d seek the counsel of a brain expert, a neurologist. If I thought my problem were physical, I’d seek my general practitioner’s counsel. If I felt that my problem were emotional in nature, I’d seek the counsel of friends, family, clergy, or in a worst case scenario, I might even go to a psychologist. I believe that pretty much covers the gamut of potential difficulty. So, that leaves psychiatry as a redundancy that’s completely useless except as causing many of the worlds problems and working as pill pushing shills of the drug companies. To claim that there are a few who don’t let their overblown ego get in the way of doing meaningful work is like claiming that there were a few good people in a Nazi uniform so we should forgive all associated with that hated symbol.

I’m really disappointed that this forum turned, first of all, into a pop psychology type of read and now it’s providing a forum for “good” psychiatrists to find haven and solace from critique. Unfortunately, I deal every day with the fallout of too many who believed they were “good” because that’s all their ego would admit. Please stop defending your profession and go seek an honest field of endeavor. If you don’t want to waste your education, go on into neurology and help people from that lofty perch.

Sorry if I’m bitter but I trusted the profession and they got ten years of my life. When I stood up and questioned and challenged, I recovered and escaped the clutches of psychiatry but, it was too late and the damage had been done. I’ve experienced the damage of over ten years worth of psychiatric drugs as they weakened my heart. I have now survived five heart attacks and I’m dying of congestive heart failure. It will kill me but, not today. I was lead down a merry path by the psychiatric profession and will die for swallowing their pills and their hermeneutic attitudes. I didn’t hear a single good reason for this profession to continue to exist for another day.

Medical doctors?
Why do we need to have *doctors* addressing emotional distress?

Aren’t there counselor, therapists who can do that?
Some (including myself) would argue that clergy, peers, friends have a huge role to play.
As does community involvement, and many other*real life* ‘therapies’.

But medical doctors?

I can see their role in looking for underlying causes of what is mis-labeled as “mental illness”:

http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

But psychiatrists are not needed to do so.
In fact, their bias toward “mental illnesses” only causes more harm than good.

The *overwhelming* majority of psychiatrists are *utterly* useless, IMO.
Especially in dealing with severe emotional distress.
Or a very *real* underlying medical condition.

They don’t have the training that many others have.
It’s much safer to seek help elsewhere.

We make this stuff so complicated.
It’s not.

Duane

I believe that the future of psychiatry is a feature in history textbooks. Children will learn about it as a historical aberration, an oddity, along with human sacrifice, witch hunting, slavery and women not having the right to vote.

Eventually people will have to have the concept of mental illness explained to them as a concept that primitive people used for a social purpose. Eventually it might even be forgotten about completely. Christianity only survives or survived in tact for 2000 years because the bible was written in a language people couldn’t understand for 1400 yrs. Ideas that are junk are going to be discarded by society at large much much faster from now on.

Critical psychiatry is really just part of the death rattle of psychiatry…. a rattle that will only get louder…. the edifice is weaker than it looks.

Dr. Bracken,
A wise friend once described Pat Bracken to me as “fantastic, the very ideal of a psychiatrist.” 😉 I agree!
Thank you so much for the great work you are doing, especially in exhorting other psychiatrists to recognize the shortcomings (and I would add, the grave dangers,) of biopsychiatric reductionism. Bravo, sir!
I hope you will continue to promote the message that “the neurobiological project in psychiatry finds its limit in the simple and often repeated fact: MENTAL DISORDERS ARE PROBLEMS OF PERSONS, NOT OF BRAINS.” Not everyone will embrace your message, of course, but some will. Courage!
Thanks again for all you do.
By the way, I LOVED the Picasso analogy. Nicely done!

A friend of mine just said to me “Don’t psychiatrists remind you of morticians a lot ?” I laughed and said ” yeah and their methods are an embalming process.”

Dr.Bracken,

Thank you for the thoughtful paper presented.Unfortunately, it can be construed by many (including myself) as promoting what you are attempting to debunk.

As a practicing clinical psychiatrist who has taught neuroscience for over 20 years, is a trained psychoanalyst, has seen thousands of patients,and is a defendant of those who ridicule the field-I find your paper to be yet another that moves us and patients-nowhere.

The paper is to my thinking, yet another fancy form of pseudoscience.Nothing more, or less.I believe your intentions are good, but significantly misdirected.

Until there is a model of the brain/mind, nobody has the right to say which is the right direction.It could be do nothing at times like Lacan, or a lobotomy or insulin shock.The point of science is to remove mythology.This paper does the reverse:it dresses it up.

Focus on meaning,values,relationships? Lets do what Einstein called a thinking experiment.Remove biology from the brain-and which of those three remain? None.Problems of persons ,not brains.Repeat the same experiment.As is in the worst of neuroscience, your paper ends with-words, not solutions.As Freud wrote in his “Project”-until his and others theories stand the scrutiny of science,they are just concepts at best, and mythology at worst.

I suggest after you have read 15000 or so papers in neuroscience, and have mastered the concepts proffered (unlikely)which cares less about whether someone gets pills or talk therapy, then you reconsider what you wrote.My patients and students thank me because I do not discuss hermeneutics with them, but rather we have about how the brain works, how dualism is destructive, and what sort of things we can to to improve peoples lives.

That said, while strongly disagreeing with your perspective as backward looking, I appreciate the heart and effort put forth.

Dr.Goldstien

Dr. Bracken,

“A reductionist approach to art appreciation would involve the unlikely idea we could reach the meaning of a painting through the chemical analysis of the various pigments involved.” This is a wonderful parallel to the awe inspiring lack of logic and insight of today’s reductionist psychiatric approach. As a fine artist, with an Artist Interrupted story, I greatly appreciate the creative analogy. I hope you don’t mind if I quote you.

I absolutely agree mainstream psychiatry today is stuck in the completely materialistic modern level of consciousness, and do hope they can transcend to the post modern level of consciousness, and even graduate to the intuitive level of consciousness some day soon, too. As a woman who moved from the modern level of consciousness to the post modern level in 1992 or so. Then had the misfortune of being subjected to the modernist psychiatric industry in 2001, I must confess I found psychiatry to be so incredibly backwards, it was impossible to even communicate with those within that, IMHO, insanely disrespectful and delusional industry. I’m glad at least some psychiatrists are starting to wake up and evolve. Welcome.

As to a hermeneutic shift in psychiatry, it strikes me that’s the societal function psychology is already supposedly filling. Although, as a person who ended up suffering from “psychosis” and “voices” from the psychiatric drugs, I will say the story resulting from these terrifying side and withdrawal effects did end up making logical sense in my life. The drug induced “voices” were the “voices” of the people whose lies (documented in my medical records) to a psychologist were used to get me misdiagnosed and drugged initially. And since my drug withdrawal induced “psychosis” actually took the form of an awakening to the story of my dreams, and as it turns out the inspiration for my artwork comes from the story of my dreams. Living through that “manic psychosis” did allow me to understand the meaning behind work I had done decades earlier, which is a good thing. But my point is that when a person suffers from “psychosis” or “voices,” these are completely relevant to the life of person. Ignoring them is absurd, ignorant, and apathetic.

I enjoyed reading all the intelligent and well thought out comments of others, as well.

A good article. I wonder what response did it get from the “professionals”?

Jonah,

I have two very specific reasons for disregarding your well articulated aversion to Dr. Healy.

1.) I have read– cover to cover– 3 of Dr. Healy’s books : “Mania”- history of Bipolar disorder; “Let Them Eat Prozac” and “Pharmageddon”. Theses are the best sources of information and historical background for mental health professionals who actually notice how much worse the outcomes have become SINCE the advent of the ‘magic bullet’ biomedical model for psychiatry.

2) I have been working exclusively on inpatient. acute- child/adolescent, young adult, and older adult units for over 20 years. My proximity to ECT has been limited to the testimony of adult patients who seek it–and request it — either first time, or repeat ECT — I have never encountered the patient who claimed to be ‘damaged’, but have witnessed improvements in severely depressed and distressed patients who requested ECT. I have had no exposure to any sort of coercive/forced ECT on anyone. While I do not discount the experiences that have led many to be adamantly opposed to ECT, I cannot find cause to vilify Dr. Healy for supporting the use of ECT, as he has never promoted forced ECT– . I also see nothing to validate the accusations by Dr. Breggin et al, who suggest that Dr. Healy is ‘attacking pharmaceutical companies’ as a means to garner more patients for ECT; that his motivation is financial gain. This is beyond absurd to me.

I appreciate your not attacking me, personally, or negating any valid points I may have made because I shared what I respect and admire about Dr. Healy. He is taking to task the key players who are indisputably destroying the lives of innocent, vulnerable people. I see no other psychiatrist who has the credentials, courage and tenacity that Dr. Healy has focused on what most commenters on MIA agree is the biggest threat to our ‘very lives’. I certainly have no intention of dedicating any of my time and energy toward finding a reason to vilify him.

Based on all I have learned from developing my practice and providing therapies that alleviate suffering and empower people, I would never refer anyone to a psychiatrist, much less seek one out for my own issues. 🙂

Respectfully,
Sinead

Dear Dr Bracken
My experience is that the Talking Treatments work very well for ‘Severe Diagnoses’, and that its the Psychiatric drugs that cause ‘The Long Term Mental Illness’ (through withdrawal syndromes).

I ended up in a Psychiatric Unit about 30 years ago following an unsucessful attempt to withdraw from long acting depot medication. The medication had been causing disabling side effects , and I was dependant on state disability benefit for the years that I consumed this drug.

While I was in the ‘Unit’ I got talking to a psychologist. He told me that everybody in there could make complete Recovery with the help of psychology, and without psychiatric drugs.

I did eventually withdraw from the depot injection, through careful tapering with oral medication. I was able to come off State disability benefit because of this, and return to gainful employment. The Talking Treatments helped me to identify how my anxiety process worked; and how to do something about it. I have remained well since.

On my first contact with Psychiatry I had refused medication and asked for Psychotherapy. But I was not allowed this option and injected with strong drugs instead. This was at World Renowned Psychiatric Research Hospital – The Maudsley, London.

What I like about Pat Bracken is that he challenges conventional psychiatry from within the institution. We need allies within the institutions.

But I think what he is offering people in distress could be offered by other professions: counsellors, social workers, psychologists etc etc.

Gratitude for all the thoughtful and philosophically / intellectually clear, nuanced, tensioned (dialectically reflective) comments and arguments provided by many commenters.

Most (of us, survivors) keep a clear focus in asking: What is this psychiatric medical expertise that now calls for neo-graecist hermeneutics? What is this new disguise psychiatrists use to position themselves as experts in making meaning of an individuals distress, magically, ehm, hermeneutically re-inserted in social (con)texts so that it needs ‘medically trained’ psychiatric experts to bring hermeneutics higher knowledge to the poor(ly) educated ‘distressed or confused”patient’.

‘Our patients’, that what this is about. Make us uneducated sods believe in another magic of medically enhanced ‘art of interpretation’ to help the wildly agitated or confused, suffering mentally ill. The ‘introuvable’ ‘mental illness’, the trick that provides the power to all the oppressive psy systems dogmatic and treatment abuse – now elevated to patriarchical hermeneutics like with the christian missionaries?

Would they refer to Socratic dialogues, very subversive and dialectic, of a man who did not elevate himself about the youth he was dialoging and co-thinking with, what a danger in the consequences in taking an equal standpoint with one’s partners in dialogue. Ah, but mental patients, they are to confused, to disturbed, they need hermeneutical guidance. Do they?

Weren’t there the Our Bounty project where SMI labelled people were most apt at chatting with and listening to their equals, most being homeless people – to the huge surprise of the mh professionals these people were most humanely street smart and soci_able in social groups specific and nuanced lives’ rites and realities (academically purified to con-texts).

Also, I assume, they were in no need of ‘hermeneutics from sophisticated doctors’ who could not make sense of daily realities as marks of the odeurs and ritualistic, very clever talk of people living in abject poverty in the streets. I much prefer social street workers and peers to ‘walk the walk’, know the ironies in seeming atrocies, who daily partake in the accentuated philosophy and silences of those in abject, oppressed or otherwise abused social-margin situations.

The academic psychiatric beauty talk, needing little understandable philosophical references as authoratative footnotes, seems an exercise of well meaning, nevertheless ‘distant, directive, discursive’ manoevre.

Not a single reference to the collective endeavours of lived, negotiated, warmhearted, inspired meetings of survivor peers, the wisdom of Deegan’s journey of a heartless heart, the radical democratic stance and collective practice of Judi Chamberlin’s On Our Own, the writings of a small German group of people with experience of extremely widened mindworlds who support each other without no professional intervention, the diverse, kind, intelligent and holistic practices in the West Mass Rec Learning Community, the importance of wamth, humour, heart and everyday practical support as reported from several African survivor organisations, the absolutely honest works of Shery Mead to claim back our extreme feelings, thoughts and troubles from the debilitating and alienating discurse of medical psychiatry, and many many many more.

So that we stay patients in need of the dubious expertise of hermeneutically, verbosity affluent, necessary medically trained doctors who want to maintain psychiatry – even when abandoning the powerful concepts of diagnoses and mental illnessess and their myth of neurological causation. So that they keep the authoritarian power over the oppressed , now sophistically as well as biochemically controlled ‘poor patients’.

Ethical and epistemological honesty, practical and social honesty – as a consequence of the interplay of moral, cultural, economic, social and intra-group oppressions and abuses found with people in extreme reactions to unbearable challenges and injustices – would lead to a clear standpoint: medical psychiatry and its harmful treatments were wrong.

Who did ask for hermeneutically enhanced post-inquisition for a more sopisticated control of witches and perverse homosexuals, who did ask for post-colonialism build on the disappropriation of indigeneous people’s properties, lands, cultures, rights – the oppressors who were the winners and power holders.

Why should psychiatric survivors wish to allie themselves with the maintainance of expertise of distant and rational academic doctors and their glass-class-castle philosophies and now ‘hermeneutics’ propaganda – lacking real critical engagement and the humble courage of fighting for better rights and opportunities together, hand in hand, with the abused, abjected and patientized.

Hoping for new perspectives from survivors and some real allies – as Jan Wallcraft and Kim Hoppers to be published work on capabilities as rights and social practices. Knowing there are courageous survivor advocates, activists, researchers, educators, film makers and allies who engage in learning, supporting, working together in the midst of shameless and crying inustices and violent abuses of all sorts, unafraid of being engaged in social movements – because in reality there are no contexts, there are multi over- and multi-empowered social groups, practices, values and missions of liberation from and fight against inustices.

Hermeneutics are artificial and bougeois intellectial exercises of the past two centuries, dominated and academically entertained by male and totally unengaged, individualistic philosophers and writers in their peer reviewed contexts.

P&H – None of our, survivors and trustworthy, equality practising allies, critically engaged work, morally positioned in the oppressed patientized sub-classes, but hopefully more and more rich of warmhearted and tensioned solidarity to empower an ongoing ‘patient liberation movement’ from psychiatric oppression, social abjection, societal and moral injustices. To advocate for better housing, better education, healing from abuse and oppression with peers who have been there (and somehow do not need hermeneutics), to advocate for a glocally respected diversity of equalities and capabilities.

Hi! My name is Mylene, and I have some thoughts I’d like to express about what I’ve read thus far of the article by Dr. Bracken. I didn’t read the whole article, basically just the introduction, because I have an issue with concentrating on extensive reading materials. I read some comments, also.

I do think that the profession of psychiatry is still necessary so that psychiatrists, who have the training and knowledge, to help people withdraw safely from psyciatric medication, can do so. Part of the reason I haven’t is the complicated process of “tapering off”. I’m on all prescribed meds now, and have been for over 15 years and I just don’t have the ability to do it by myself. It seems to me that in today’s world, if all the people suddenly realized that we made big mistakes in our treatment of the mentally ill, myself included in the latter, that we would still need trained professionals to clean up the mess the psychiatric profession has made. At least that would be an extremely helpful and valuable service to me in my life.

Also, Dr. Bracken made a good point about the somatic differences associated with so-called “‘abnormal’ mental states/conditions” (not the words he used) and how a profession which has both medical and psychological training could be beneficial to those who are affected by somatic symptoms, as well as psychological/mental symptoms.

They could also be helpful in re-educating the public by exposing themselves for what they have been, perpetually deceiving and lying the public and sometimes themselves and each other about the pharmaceuticals they push on us, while telling us we need lots of drugs in order to live a “more normal life and function in society”. They could be part of the process of our healing and journey toward health and worldly fulfillment rather than what they have been, which for now is still part our problems.

I don’t think this society is anywhere near making even that much of a breakthrough in its mental attitude towards the mentally ill; and changes of this nature don’t seem to happen instantaneously, to say the least. Social changes are notoriously slow, from what I understand. Although the times are changing, there are still too many conservative politicians, conservative voters, and too deeply and extremely conservative of both types to be dead set on a world of no psychiatrists to happen at the snap of a finger. Right now is what it is, we are not even close to that, and I have great respect for anyone who wants to bring positive change closer to this current reality.

I would also like to add that I don’t care what exists as long as no one is forced to be subjected to it. However, knowing what I know now is possible for psyciatry to have ac tuallly become, and the ignorance so prevalent in so–called “free” society, I would prefer to be forcibly subjected to kindness than cruelty, if I was only given those two choices with regard to my “treatment”. I want to think that Our Story is inching closer to freedom for all rather than extinction for all. Unfortunately, I think those are the only two options at this time.

I’ve been rambling, but in conclusion I’m going to say that Dr. Bracken seems to be working to bring people closer to freedom rather than to certain destruction, and I felt motivated to respond basically more to some of the comments than the article itself.

Dr. Bracken, bravo for entering the MIA den of lions! But:-

“However, interpretation and ‘making sense’ of the personal struggles of our patients are to psychiatry what operating skills and techniques are to the surgeon.”

Not quite, since such interpretation and sense-making are skills possessed in varying degree by most people much of the time, and which predate psychiatry by thousands of years. Like ALL people, I often make, accept, trust and act on interpretations of my and other’s personal struggles. But I’ve never performed surgery on anyone and when I needed kidney surgery a decade ago the only person willing to do it was a urologist, for some reason…

More seriously, may I suggest your vocation and experience as a therapist are more vital than your training as a psychiatrist. I do value the profession of psychology. And I do think psychiatry can be useful to the extent that it combines psychology and medicine, as mind and body ARE obviously related, a fact denied by dogmatists (some on MIA) who often hate the ENTIRE medical profession. But a combination of psychology and the law, or psychology and accountancy, or psychology and sociology, etc, could be just as useful.

Incidentally, if the tub were full of ELECTRIC eels, was that how ECT was invented?