Psychiatry is fast approaching a death spiral which we as a society may not be able to recover from. In many residencies, psychotherapy is not even being taught. Many psychotherapists of all professions – psychiatric, psychologists, and social workers – have been intimidated by specious neuro-biochemical theories, while others have simply given up. And now, there aren’t many remaining good therapists in practice anymore.
The chemical imbalance theory of somatic psychiatry has almost completely replaced a genuine understanding of human struggle. The underlying theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person. Treatments that follow from this simplistic, mechanistic, and reductionist notion have been intended to act directly on the brain, which in my experience leads to problematic and misleading outcomes.
The real source of human suffering is not the brain. Suffering is the experience of a person, a human being, in the context of damage to his or her play of consciousness. This damage is the consequence of deprivation and abuse in our emotional environments during the formation of our personalities. This takes place in relation to the unique constellation of our temperaments.
My life’s work has taught me that the art, the science, the discipline, and the wisdom of psychotherapy attends to this damage. Tragically, over the course of one generation, psychotherapy has become almost extinct and has been replaced by drugs. There are no miracles and no shortcuts, such as what drugs — and their bedfellows, ECT and lobotomies — always promise. We have repeated the same mistakes over and over again, and we are doing so today.
Even the APA, when pushed, acknowledges that the chemical imbalance theory is not really true. Never mind that this simplistic and false theory lacks any credible validation. They now add in that there are also vague, environmental factors — whatever those are — but this is all a ruse. ‘Chemical imbalance’ has been accepted by psychiatry and the general public as completely true. People believe that psychiatric conditions – so-called ‘biological depression’, anxiety, psychoses, and even the fictitious ADHD – are ‘illnesses’ that should be treated with pharmaceuticals such as antidepressants, benzodiazepines, anti-psychotics, and amphetamines. (See – “No It’s not the Neurotransmitters. Depression is not a biological disease caused by an imbalance of serotonin.”)
In addition, it is common that therapists are confused by contemporary neuroscience. I find the explosion of neuroscience a wonderful thing. To discover how the brain works is illuminating and fascinating. Any theory of mind has to be consonant with the way the brain actually works. However, a superficial understanding of neuroscience often mistakenly seems to support the neurotransmitter-based theories of the mind. What many neuroscientists don’t understand is that an understanding of the brain also has to be consonant with the way human nature actually operates.
Human nature operates through our consciousness. The more we understand the workings of the mind, the more we come to understand that consciousness is organized in the brain as a play; as stories, with characters, feeling relationships between them, scenarios, plots, landscapes and set designs. We evolve our characters over the course of twenty or so years of child raising. The biology of the brain creates and informs our character as a whole. Parts of the brain — such as neurotransmitters and the various brain modules — do not operate independently. They operate as a whole to simply create the play of consciousness itself. (See – “The Secrets of Consciousness, the limbic-cortex is organized as a drama in the brain.”)
Psychiatric problems reflect how the traumas of deprivation and abuse, in concert with our temperament, create our character. Psychotherapy is the best way to heal from the pain and “symptoms” of being human. In the context of a safe therapeutic relationship, we can mourn the problematic pains of our lives, and write a new play that is more consonant with loving and authenticity.
Human beings have complex inner lives, and psychiatric problems flow from the great mysteries of life. The idea that human struggle reflects a problem with neurotransmitters is absurd and insulting on the face of it. We do not suffer from mysterious brain diseases. To truly be a psychiatrist in the spirit of what was always intended, requires a lifetime of dedication to plumb the reaches of human mystery.
I very frequently get comments from other psychiatrists who say, ”I give antidepressants and do therapy. It helps the therapy”; “Why limit yourself to just therapy as if one size doesn’t fit all conditions. Use everything in your arsenal and give drugs when they are needed.” Many psychiatrists believe that walking some middle road is an open-minded and superior position. Anything different from this is deemed to be dangerous and narrow minded.
This, of course, begs the most important issue – do antidepressants, benzodiazepines, amphetamines help, or do they cause harm? If one studies the real efficacy, they are not useful. I’m making a stronger case than that they are just not useful in the long term. Even regarding short term crises, i.e. depressed, suicidal, or anxious, etc. the use of drugs is misguided. It is, in fact, not hard to reach a patient, which results in the short term crisis passing. The very introduction of a drug removes it from the human sphere and falsely confirms that a crisis is a biochemical disorder and needs a biochemical fix. This is not true. Once people falsely believe a drug fixes what ails them, they depend on that drug. The real issue, whatever it may be — anger, masochism, etc. — needs to be addressed in a real way to truly get to the bottom of it. I believe these uses of drugs interfere with therapy, and do not permit real mourning and healing. Real therapy is useful under all circumstances.
When our current prevailing fad passes — and it will — what are we going to be left with? Our psychiatric community will be composed of empty prescription pads with nowhere to go. We have lost our center. And don’t worry; contemporary psychiatry isn’t planning on folding its tents anytime soon. My fear is that it is already too late. The hope for the future depends on young professionals who think for themselves; people who are drawn to quest for the real item. But who is going to teach them? Will we have to start all over again?
I hope that those of us who remain true, will rise up and put a stop to the present travesty. We need a clear paradigm by which science contributes to a fully lived human life, rather than diminishing it. We need to understand the real implications of psychiatric drugs. We need respect for our patients’ autonomy as they face their issues in therapy. We need to re-establish the proper place of psychotherapy, and passing its wisdom on to the next generation has to be our goal. I hope self-respecting therapists will make their voices heard and not be intimidated by the profound pressures of the APA and big Pharma.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.