On Becoming Critical

Jeremy Wallace, MD
31
271

In order for you to understand where I am coming from, you probably need to know a bit about how I got here.

Nearly 4 years ago I moved with my Finnish wife and children to live in Finland. I had been living and working in London, where after graduating from medical school, I had trained and worked as a psychiatrist. My final job in London was as a NHS consultant psychiatrist in old age psychiatry in South London. Old age psychiatry in the UK, in effect, means dementia care. In retrospect I think I’d found dementia a lot less problematic, conceptually, than the messy world of adult mental health care.

For various reasons I wasn’t particularly satisfied with this work, and in thinking about what we wanted for the future, professionally and for our family, my wife and I began to explore the different options. On a holiday in Finland to visit my wife’s family the idea was born that we could move to Finland. I made it clear early on, however, that I could only do this move if I could find some work as a psychiatrist. At the time this seemed pretty impossible, especially as I didn’t speak the language. On coming back to London, my wife periodically looked at Finnish estate agent websites and I started putting my feelers out regarding work in the Helsinki area.

The following summer we found ourselves in Finland again, this time we had found a house we were interested in, put our own London flat on the market and I had managed to organize a meeting with the lead psychiatrist at a nearby hospital. In the space of a week we made an offer on the house, I’d been given work and an offer had been made on our London flat. It seemed that all the forces of heaven and earth were saying, ‘go for it’.

I remember that first meeting with the psychiatrist well. We spoke in English. It was a hot sultry day. He seemed keen for me to come and work with them. I was offered work in the local psychiatric hospital, on a mood disorders unit, on the proviso that I learn the language. I would be given a period of grace, where I learned the language by shadowing another doctor. At the end of the interview I told the interviewing doctor I was a socially orientated psychiatrist. He said that was fine, as long as I wasn’t against prescribing medication. At the time I had no particular problem with prescribing medication, and I told him so. The irony of this conversation was to come much later, once I had started work.

The following April we moved to Finland and at the beginning of May 2011 I started work. I’d spent the winter taking classes in Finnish but I was in no way proficient. They say Finnish is one of the hardest languages for someone from the Anglophone world to learn and I quickly realized I’d set myself a herculean task. As agreed, I started shadowing a doctor, a trainee psychiatrist. I spent my mornings listening in on clinical encounters or participating in discussions and my afternoons learning the language. And it wasn’t only the language I had to learn but also a whole culture, including a new medical culture. It was frequently frustrating and very tiring. Each day I would feel exhausted in a way I hadn’t experienced since residency days and long nights on call.

There was a flip side. I now had the opportunity to sit back and observe what happened in a busy psychiatric clinic on a daily basis. Having previously completed an MSc in Anthropology, I understood this to be a form of participant observation. This proved to be a very fruitful time for me intellectually. Not only did I question what was happening around me on the inpatient unit, or in meetings but I began to question the very underpinning assumptions of psychiatry. Despite not understanding the language fully I could see, through body language as much as anything, that there was a serious disconnect between the story the patient told (usually of dealing with the chronic fall out of a troubled, abusive upbringing and being confronted in the present with a major life crisis or series of crises) and a medical system that all too often sought to recast the patient’s suffering as a medical problem. Initially I questioned the diagnoses, in the end I called to question the whole system of psychiatric diagnostic classification.

On a book shelf at home I had a book called Toxic Psychiatry by Peter Breggin, ironically bought a long time ago but never read. Seeking some understanding of these observations, I remember, one day, picking the book off of the shelf and starting to read it. It was a warm, light, Scandinavian summer’s evening and I avariciously devoured the book, something within it resonating with what I had been observing.  It also began to make sense of a number of conundrums and confusions that had plagued me throughout my training and career. Over the coming months, I read more: Richard Bentall; Joanna Moncrieff; and Bob Whitaker’s books, to name a few. I think I came to a point, as Thomas Szaz once put it, where I saw through psychiatry. This newer understanding of mental health and its care brought with it excitement, but it also brought sorrow and anger. It was as if I now had to relearn everything I’d been trained to do.

A sudden turn of heart towards critical psychiatry didn’t, of course, come out of the blue. This had been a long journey already. Throughout my training I had struggled with much of the theory and practice of adult psychiatry, and for this reason I had gravitated towards old age psychiatry, where at least I felt on firmer ground when dealing with a bone fide brain disease like dementia. I remember sitting in academic, grand rounds as a trainee psychiatrist wondering why everyone got all hot under the collar about ‘finding the right diagnosis’; surely it didn’t matter, I thought, particularly as the treatment will end up being the same; it usually meant the difference between a mood stabilizer or not!

As I mentioned earlier I had done an MSc in Anthropology. Specifically this was an MSc titled, Culture and Mental Health run by Professor Roland Littlewood at University College London. The MSc provided me with my first real critique of psychiatry: I think Roland Littlewood (1990) puts it most succinctly, where he suggests that trans-cultural psychiatry should not primarily be comparative i.e. finding goodness of fit between western psychiatric categories and local forms of distress but rather an investigation into how psychiatry itself is constructed. What Littlewood questions is whether the idiom of pathology and disease in psychiatry can ever be fully independent of the cultural, political and social context in which that system arises. In other words the very labels we use to label mental distress are not biological entities but rather social constructions, laden with cultural baggage. This is something I aim to return to in a later blog post. Another important influence had been my wife. In the years before moving to Finland, she had completed a doctoral clinical psychology training at the University of East London (UEL), UK. The course was set up by Mary Boyle, arguably one of the pioneers of critical psychiatry. UEL is one of the few places in Britain where you get training in critical psychology. During the years my wife was in training, I remember having many challenging discussions about psychiatry.

It was, however, my own personal experience of suffering a breakdown that was perhaps the greatest significant influence on my thinking. Whilst at medical school, there was a time when it felt my inner world fell apart. I won’t go into details here except to say that it encompassed a range of symptoms of which massive fear was the central feature. At the time I resisted all labels. I was sent by the university to see a psychiatrist but refused the treatment he offered. Eventually a friend pointed me in the direction of a psychotherapy service called the institute of self-analysis, based on John Bowlby’s work. Through them I found an affordable therapist and started the long journey from the very dark place my life had become. I survived medical school and becoming a doctor by putting on a brave face, and masking my symptoms as much as possible. My recovery remains an ongoing project, though these days I consider myself sane and happy.

Throughout my psychiatric training I had always, in the back of mind, this question: What is the difference between my suffering and those of my patients? How come they get all this treatment and I got none?  Why do they have a ‘brain disease’ (there was a time when I tentatively believed in this sort of thing), whilst I, who was at times symptomatically severe enough to warrant medication, have no brain disease? Or do I have a brain disease? It was partly these questions that Peter Breggin’s book and others began to answer. The answer seems plain to me now. I had suffered exactly in the same way as many of the people I see every day do, but I had been lucky enough to avoid labeling and drugging. I had never fallen into the trap of psychiatry. There never was anything wrong with my brain, and likewise my patients – in all likelihood – have normal brains, save for the changes the medications have caused. What they struggle with (like all of us) is the stuff of life: their own histories; failed relationships; loss; identity; belonging; and self-acceptance, to name a few.

This understanding has had a profound effect on me and my clinical work. For myself it was part of my own healing and recovery. I’ve understood how different my journey might have been if I had gone along with the psychiatrist. I feel lucky to have found a way through the dark night of my soul. And as for my patients, I’ve stopped seeing them as some ‘other’ with a definable problem. I’ve stopped trying to work out what the diagnosis might be. I’ve started to see them as persons, each with a unique history. I’ve stopped trying to separate myself too much from their pain. The clinical barrier has come down. “Thou art that,” as the Upanishads declare. Most of all I know a full recovery is entirely possible, but as the late singer songwriter, Nick Drake, once put it, “it may take a little while to find your way in the end.”

* * * * *

Reference:

Littlewood. R, British Journal of Psychiatry 1990, 157, 294-297.

31 COMMENTS

  1. Welcome brilliant doctor!

    “Despite not understanding the language fully I could see, through body language as much as anything, that there was a serious disconnect between the story the patient told … and a medical system that all too often sought to recast the patient’s suffering as a medical problem. Initially I questioned the diagnoses, in the end I called to question the whole system of psychiatric diagnostic classification.”

    Absolutely correct, most psychiatrists and US psychologists “recast the patient’s [real life concerns]… as a medical problem.”

    “…I saw through psychiatry.” We need all the doctors to get there, pray to God for the day.

    “This newer understanding of mental health and its care brought with it excitement, but it also brought sorrow and anger. It was as if I now had to relearn everything I’d been trained to do.” Psychiatry is fraud on an enormous scale, all psychiatric training is based on bogus science and misinformation about the toxic psychiatric drugs, I understand your sorrow and anger. And thank you for expressing it.

    “I remember sitting in academic, grand rounds as a trainee psychiatrist wondering why everyone got all hot under the collar about ‘finding the right diagnosis’; surely it didn’t matter, I thought, particularly as the treatment will end up being the same; it usually meant the difference between a mood stabilizer or not!”

    So true, according to my medical records, my doctors didn’t bother worrying about a correct diagnosis. Three different doctors within three days claimed the adverse effects of Wellbutrin, given for smoking cessation not depression, were “paranoid schizophrenia,” “bipolar” and “depression caused by self,” and these diagnoses were based on lies from alleged child abusers and a PCP who was paranoid of a potential, but nonexistent, malpractice suit. So much for the “reliability” of psychiatric diagnoses. The whole point is railroading as many well insured people as possible into the disempowering “system” for profit, or sometimes just for the personal financial motives of unethical professionals.

    “[T]he very labels we use to label mental distress are not biological entities but rather social constructions, laden with cultural baggage.” In other words, not medical diseases, but fraudulently being marketed as such by the mainstream medical community and pharmaceutical industry. Thank you for pointing this out, doctor.

    “There never was anything wrong with my brain, and likewise my patients – in all likelihood – have normal brains, save for the changes the medications have caused.” It is the drugs that cause the “chemical imbalances” and many of the DSM disorder symptoms. Wouldn’t it be wonderful if we could some day end all this unjust, for-profit, iatrogenic harm of other human beings?

    “And as for my patients, I’ve stopped seeing them as some ‘other’ with a definable problem. I’ve stopped trying to work out what the diagnosis might be. I’ve started to see them as persons, each with a unique history. I’ve stopped trying to separate myself too much from their pain. The clinical barrier has come down.”

    I hope some day the rest of the doctors will learn that you can’t help a person by declaring the person’s actual concerns to be “fictional,” stigmatizing the person, and “torturing” the person with tranquilizers. This odd behavior is, of course, counterproductive, to the wellbeing of all the patients. I’m so glad you now realize this.

    “Thou art that,” we must all learn to respectfully coexist because we are all part of the same. “Now take a little while to find your way in here. Now take a little while to make your story clear … Let’s sing a song
    For Hazey Jane. She’s back again in my mind. If songs were lines In a conversation The situation would be fine.” I knew a “Hazy Jane, ” she was one of my ex-pastors (I’d been drugged up based on lies from her co-pastor, who wanted to cover up the abuse of my children.) Working on my story, trying to make it clear. Oh, how convenient for me, it seems songs may actually be lines in a conversation, so hopefully all will be fine. “Lets sing a song for Hazy Jane,” and pray she wakes up some day. And same for all the psychiatric practitioners.

    Thanks for your accurate diagnosis of the insanity of today’s mainstream psychiatric system, Dr. Wallace.

  2. I am glad you have got to this space. I remember years ago dealing with wretched devastating life issues (not gonna give any details but think parade of horrors), the therapists I worked with holding a similar view and explicitly warning me to watch out against me or my children falling into what they called the “psychiatry trap,” that my oldest was a sweet little boy and there was nothing wrong with him or me but that we’d had bad times. They warned me not to go the labeling and medication route, and had us do cognitive therapy, talk therapy, play therapy, and similar rehabilitative approaches. They cared. I’m glad they cared. I no longer have nightmares, and neither does my oldest. We’re living a nice life now, after the suffering we went through. My son has asked for permission to test out of high school and go early to college. I can hardly imagine what his life will hold.

    I feel like I ‘cheat’ some though, and take a medication for a physical disability which has the side effect of significantly lowering my blood pressure and heart rate, of calming me. I’ll be honest, I’m a much better person and do better in life taking this pill. My life gets better and better while I take it … and worse when I go off it as I eventually become overwhelmed by situational stress. Am I cheating? A two dimensional analysis, you know. Hard to get out of there. It works, so I do it. The question is the answer.

    I’m glad you care. It is easy to see, once you let yourself. 10,000 years from now what will they think of our culture? Money is a symbol of social status. People get ‘paid’ to exchange social status tokens, to do the rituals of ‘buy’ and ‘sell.’ ‘IQ tests’ that really measure social position, and the sister ‘standardized testing.’

    Instinctual compulsions. I’m glad you see. Take care. You’ll see more and more. Take care sweetie. I enjoyed reading your writing, you think clearly and write well. God bless you. It is a strange world we live in, us rutting wild animals.

  3. Dr. Wallace,

    I found your article to be very inspiring and it gives me a great deal of hope that someone like you being trained in traditional psychiatry could see through this corrupt paradigm and recognize that yours and your patients’ humanity are the same and equally important and valuable. I was especially impressed that you saw your “patients'” problems were much like your own as fellow human beings.

    I hope you keep up the good work while continuing to spread the word to those in your profession at MIA and elsewhere until many more share your helpful, humane, compassionate, humble (in a very good way) and caring approach to those you encounter. Many of us at MIA went through the same type of journey to our “enlightenment” about mainstream psychiatry including finding Dr. Peter Breggin’s life saving books and others throwing us a lifesaver.

  4. Thank you for this. I also am a person who got through an intense difficult time as a young adult and who went on to become a therapist and for the last 23 years a ‘peer-professional.” I have found that sharing a bit of our common struggle and lived experience with the people I work with to be an important foundation of trust and respect…

    My 19 y.o. son also came through a two week period last summer in which he experienced deep fear and mistrust…something that could be called an extreme experience. We used an Open Dialogue informed approach to work through this as a family and he is now back in college and feeling and doing great. BTW he wants me to share his story to make sure others know that people can get through what some may call ‘psychosis.’

    Thanks for becoming who you are…glad you’re on MIA

  5. Dr. Wallace:

    Welcome! This story begs a sequel! Keep up the good fight on every level. You are much needed.

    I too, have experienced a long period of fear; In my twenties, when I was arguably at my intellectual and physical peak, when I should have been contemplating with excitement all that life had to offer, instead, partly due to the work of Dr. Caldicott and the Union of Concerned Scientists, I internalized a fear of nuclear Armgageddon that was so overwhelming at times, it diminished my ability to form strong emotional connections with people and make basic plans for the future. Thankfully, I sought alternatives over conventional psychiatric help and with the help of friends and family, I was able to overcome the paralyzing effects of fear and depression.

    Ironically, my greatest anecdote to fear and anxiety turned out to be engaging in democratic due process (!!) by organizing; ultimately leading to committing civil disobedience. Oddly enough, being incarcerated on numerous occasions had the strange effect of making me feel empowered; it also opened my eyes up to the despicable and racist conditions inside our corrections/prison system; with each passing year I say I’m going to do some organizing work around prisons but I always get sidetracked. Today, the psychiatric survivor movement needs to have a major dialogue with the prison justice folks because these well intended folks who have their roots in the Catholic based movement to end capital punishment who are uniting with mandatory sentencing reformers and ACLU advocates are actually charging jails and prisons with not providing enough psychiatric care to inmates! We have to get the word out to these well intended reformers and Catholic nuns that female prisoners who are dealing every day with racism,violence, addiction, poverty, illiteracy, domestic abuse, lingering effects of child sexual abuse and neglect, etc. are increasingly being pathologized, diagnosed, and medicated. The woman’s prison population is becoming increasingly obsese; prison food is atrocious in quality, there is zero access to nature, and massive quantities of psych drugs being shelled out at these facilities for bogus ‘diseases’ so PLEASE if you are a prison reformer, please don’t go on about how women in prison need more access to mental health care because we all know what more access to mental health care means: it means more pills. When female prisoners are discharged, they are usually lacking in medical insurance and they must spend their first several months going through cold turkey withdrawal from the psych meds that they received in lavish amounts while incarcerated. This makes them even more at risk of relapsing on street drugs, because the debiliating effects of coming quickly off Zyprexa, Abilify, Seroquel, can be partly assuaged by a number of street drugs.

    Sorry I sidetracked. We are all looking for a way to overcome fear. Fear is really the great equalizer. When doctors see the harm of the system under which they are working under, they fear to lose their livelihood, but on a spiritual level, some fear losing their integrity or ‘soul’ even more. So we make choices. You have made a choice to be openly critical of your profession knowing there may be professional consequences.

    But your choice to face your fear head on has the ironic affect of making me less fearful since one of my greatest fears today is for one of my children to become permanently harmed by psychiatry.

    When I contemplate how easy it is in our society for people experiencing distress to become labeled and become victims of iatrogenic harm, I feel the world is a very unsafe place for ‘maladjusted’ types like me. But when I see evidence that people who belong to a profession (or guild) that has harmed many people are capable of having a change of heart, it gives me hope and diminishes my fear. For that, you have my gratitude.

    • “Today, the psychiatric survivor movement needs to have a major dialogue with the prison justice folks because these well intended folks who have their roots in the Catholic based movement to end capital punishment who are uniting with mandatory sentencing reformers and ACLU advocates are actually charging jails and prisons with not providing enough psychiatric care to inmates!”
      That is sadly true. Many liberal people have a false impression that if you only ship the “mentally ill” to hospitals and hire more “professionals” we will be all better off and human rights will be protected. This is how prevalent the myth of psychiatry and its chemical cures is. These people don’t recognise that there is little difference between prison and psych ward and if there is is usually in favour of the prison. Nor are they informed about just how bad the current “treatments” are (even if there is some common recognition that people are “overdiagnosed” and meds are “overprescribed”).

  6. This is a lovely narrative of personal discovery, thank you.

    I found it particularly interesting because ever since I transitioned from medication, diagnoses, and got untangled from all that mess in order heal and move on in my life, I’ve fantasized about the parallel reality of NOT having turned to psychiatry and the mental health field when I first felt crippled by anxiety, confusion and mental chaos. What if I had turned to someone who would have simply been able to recognize that I was suffering from the end result of having lived in a toxic family dynamic for so long, which impaired my self-perception and altered my reality at the time? That’s what it turned out to be.

    But instead of investigating my life circumstances, I was given a diagnosis and medication, which, after 20 years, had devastating effects on my mind and body. THAT is where my dark night of the journey began.

    So, in essence, I would not have had a dark-night-of-the-soul had it not been for psychiatry and mental health services. I would have simply done the healing from insidious family relationships when I first showed symptoms, and more than likely, that would have been that.

    Instead, I got the opportunity to sink into the most complicated and overwhelming network of physical, mental, emotional, and spiritual malaise of my life, rife with political and socio-economic issues as well. Add to that stigma, discrimination, oppression, and going head to head with corruption (for which I chose to seek legal services).

    As a result, my healing and personal transformation were bigger and better than ever, and life has been remarkable ever since, spectacular, in fact.

    I no longer have anything at all to do with mental health services or any kind of services, that’s all behind me. I just post and read here to keep up with the shift that is going on in this arena. I find it exciting and, without a doubt, totally necessary. I think as these radical changes occur in the mental health industry, this will ripple quickly into the world.

    Had I simply gone to see a spiritual counselor and had had the opportunity to be heard about how I was feeling in my family (in mental health care, that would mean that something was ‘wrong with me’) and found some clarity there, I would not have had the amazing experience of a complete breakdown with my system, thanks to all sorts of psych drugs, along with facing oppressive discrimination, and then recovering, healing, and shifting out of that reality completely. That was the experience of a lifetime.

    In the end, I’m more grateful for my experience than I can say, because it has taught me everything I need to know to be happy in life, and grounded in my body. Still, I would so much like to see others have an easier time of healing–much easier. What happened to me as I went through the system, was completely unnecessary, and added insult to injury, literally!

    From what I’ve been able to gather, there is no complete healing and moving on in current ‘mental health practices.’ That world is where a temporary issue, easily remedied in other modalities, can easily become chronic and evolve into some lifetime condition. That’s what I’m really tired of seeing, as it destroys spirits, lives, and communities–all for money.

    Thank you again for this most interesting read. Very best wishes as you continue to question the field and fight the system!

  7. welcome and thank you for this. please keep fighting the fight from within on behalf of all the victims.

    i am the wife of a great guy destroyed by the “system”. he is currently trying to reclaim his life but i’m not yet sure how this story will end- for him, for me or for our innocent, devastated children.

    it is so crucial for someone in your position to raise his voice. you have a credibility the rest of us do not have.

    ty again. be well,

    erin

  8. If you have never had to deal with psychiatry, you think that psychiatrists know what they are doing and naively ask for their help.
    Once you are trapped, it is jolly difficult to get away from them again. They have powers they shouldn’t have to pursue you, detain you, drug you against your will and to traumatise you for life. They don’t listen. They think they know better. After all they have been to medical school. They believe unquestioningly what they have been taught. Then there are the NICE guidelines the psychiatrists have to follow. They can be a bit of a trap for the psychiatrists themselves. Lastly they are terrified of being sued and losing their job and they lie through their teeth to protect each others backs Never mind the poor patient! That is my experience of psychiatry in Britain

  9. Jeremy

    I have worked almost 22 years as a therapist in the community mental health system and I blog here at MIA.

    Your transformation was very informative; it will be interesting to see where your new found understanding brings you, especially if you continue to work in that hospital. I hope you write more about how one maintains a strong moral stance and practice while working inside an overall oppressive system.

    I once thought about writing a blog entitled “How to work inside the community mental health system without going crazy or getting fired, or both”. We are on a very precarious path, as you already know, or will soon find out. Welcome.

    Richard

  10. Hi Dr. Wallace, It seems like looking at your article two days ago led me to read this today–

    http://edge.org/conversation/parallel-memories-putting-emotions-back-into-the-brain

    The link had been sitting awhile on my favorites; still, when I read it, my understanding developed in light of your point about labels. That emotional experiences aren’t different in type, but getting pigeon-holed as diseased and defective is different from working out your feelings. Anyway, what I was brought to consider here was LeDoux’s neglect of any mention of the major mental illnesses, although he roundly includes all the basics of traumagenic models. The plus side to this originates with the reader who goes on believing in a universality of emotional and cognitive varieties of lived experience, seeing people as people and problems as problems, and not inventing mental illness to obscure the perception of either or how the relations in which they stand. The negative side is, the prominence of the image of mental illnesses and the marketing and judicating that goes on in their names, means that he would not be able to state his case precisely the same way if he were to include these issues. However much he advances his readers’ knowledge, they still have to believe in the whole separate modes of being human argument that psychiatry promises to handle in order to protect the normal from the insane, unless they have researched the alternative critical views. What I’m thinking could be said better, and the key point to me is that you can’t begin to explain cognition and emotion, much less waking, sleeping, and dreams, if you isolate or omit from your considerations the fact the extremes psychiatry sets out to study find a place in your overall explanation. A place entirely visible from the surface. I liked getting the information, but it settles nothing the problems of managing problems that psychologists shy away from or that neurologists avoid, that involves the nazi-tattoo of a label. Because of your fresh reminder of the odious effect of that consequence, I could keep facing the truth of how out of the way authentic protest against psychiatric oppression really is.

  11. I appreciate your candor, and your willingness to speak out. I think that its true, that our awareness of what we do as therapists or psychiatrists depends to a great deal on our emotional awareness, and progress in our own emotional development.

    Unfortunately, training often seems to be nothing more than amassing more and more knowledge, rather than becoming more and more conscious, more aware of what we feel and experience as human beings.

    Apparently it is next to impossible for intellectually based training programs to understand this, and it often results in becoming insensitive to what your supposed to be sensing.

    There is simply no intellectual substitute for compassion, understanding, empathy, caring. Connecting with people through your heart,and not necessarily your head.

    In the United States Psychiatry, as its practiced has become a sort of cattle drive, wherein people are placed on psychiatric medications, as quickly as possible, without regard to the consequences.

    The result has been catastrophic.