During my lifetime I have witnessed the fall of Freudian psychiatry and the ascension of molecular psychiatry. Unfortunately, we have gone from the frying pan into the fire. I certainly do not subscribe to old-fashioned psychoanalytic ideas which had been beset by considerable problems throughout the years. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of responsiveness to our patients. Although my own roots were in psychoanalytic psychotherapy, I moved on to develop the psychotherapy of character. It is a specialized form of human engagement that repairs the damage to one’s character by acting on the play of consciousness in the very way that it formed in the brain and consciousness in the first place. The psychotherapy of character is an art and a science that bridges the old divide between psychotherapy and the brain.
In today’s very small world, we have the presence of exciting, yet confusing and conflicting, deeply held belief systems — religious, ideological, political, scientific, and technological. Human belief systems have always served the human quest in its efforts to grapple with the mysteries of life. At the same time, they offer the allure of false security and leave us subject to the hubris of “belief” itself. False or outmoded beliefs may give us short-term comfort, but are destructive to our well-being. They make us susceptible to Pied Pipers who promise salvation as they lead their followers off the cliffs; or Chicken Littles who intimidate people by preaching that the sky is falling; or purveyors of false knowledge who offer false hope, quick fixes, and magical solutions while creating slavery and blindness. A new and inclusive paradigm that is consonant with new knowledge and old wisdom is so important for psychiatry and society at large.
I love and value the work of psychiatry. Nothing is more gratifying than helping people heal from painful experiences, and to fulfill their ability to love and recover their authenticity. I am proposing a new and different paradigm for psychiatry. It shows the biological adaptation of our personality and how it is formed. It shows how our temperament digests responsiveness, deprivation, and abuse, creating and elaborating, the ‘Play of Consciousness’ in the brain. We can see how and why it breaks down into psychiatric symptoms. And how recovery takes place through the psychotherapy of character. The processes of recovery turn out to be the very same forces that created our problematic plays in the first place. None of this takes place at the molecular level. I devote a blog to this – “There is a New Paradigm for Psychiatry – It is the ‘Play of Consciousness’, not molecular brain diseases.”
In this blog I will address my take on ‘molecular-biological’ psychiatry. ‘Biological psychiatry’ is the current incarnation of somatic psychiatry—insulin shock therapy, lobotomy, and electroconvulsive therapy—which views the cause of human suffering to be the brain itself, rather than the person. Unfortunately, the one thing we learn from history is that we don’t learn from history. This is never more pertinent than in the hidden story of somatic psychiatry. To fully appreciate the danger of its current incarnation, psychiatric drugs, we must take somatic psychiatry out of its state of amnesia. Its predecessors should serve as a reminder, a morality tale, for the excesses and depravity to which conventional psychiatric knowledge and practice can easily sink.
Its treatments have been to act directly on the brain—physically, electrically, or chemically. The current form of its doctrine is that problems come from genetic or developmental neurobiological disorders of the brain. And the prescribed treatments for its phantom brain diseases are psychoactive drugs. The cure for human struggle has been reduced to a pill, as if pharmaceuticals address the agency of human suffering. This has resulted in a destructive psychiatric drug epidemic, with psychiatric drug sales topping seventy billion dollars a year. Even worse, we are drugging a generation of our children with amphetamines and Prozac. ‘Biological’ depression and its Prozac cure are now so firmly embraced by psychiatry and our culture at large that it seems preposterous to even suggest that it is an urban myth. Yes there is depression. No, it is not ‘biological depression.’ The depth and scope of what it is to be human has been exiled by this dangerous and destructive practice. The source of human suffering—and our psychiatric conditions—is not now, nor has it ever been, a brain disease. Psychiatry is in crisis. And we, as a society, are in crisis. It is of the highest urgency to save psychiatry from itself and save society from today’s psychiatry.
Sad to say that one of the great culprits in the sorry history of somatic psychiatry has been faulty science itself. Its brain theories have been substantiated by the science of yesterday and today, validated in the professional journals. The truth is that no one has ever shown that there is a molecular basis in the brain that creates psychiatric symptoms in the first place. Today, it is completely believed that everything is caused by neurological-synaptic ‘imbalances’ where the neurotransmitters – serotonin, dopamine etc. generate psychiatric diseases.
What is lost here? We have thrown out the collective wisdom and mystery of the human condition, and relegated it to imaginary brain diseases. Psychiatry should encompass the contemporary science of the brain and consciousness, while honoring the wisdom of the past and its grasp of the depth and complexity of the human condition. Woven throughout world history and all cultures is a rich mosaic of wisdom about the mysteries of human nature and human struggle. It has been part of our enterprise since the dawn of humanity. It should be our enterprise today.
However, molecular mechanisms are not causal. They simply reflect the adaptations of the brain which operates on a much higher level of the mappings of consciousness. When individuals readapt in a less problematic way, this is also positively reflected molecularly. This is achieved by good psychotherapy. It happens spontaneously, all by itself.
The real history of ‘biological’ psychiatry shows the science to be faulty in method and fraudulent in its application. The multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially corrupted and manipulated. They have engaged in study suppression, falsification, strategic marketing, and financial incentives. Yet the methods and practices of this very deficient science are never questioned. Instead, it continues to get a free pass and remains the respected authority. Yet this science presumes to define what is considered scientific. We move right along.
Our sacrosanct science has continued over the past 75 years to validate that the next new and improved drug will cure what ails us. Most of those drugs are advertised to be efficacious, non-addictive, no side effects, no habituation, no drug tolerance, no high. But it never happens. Look at a partial list – bromides, chloral hydrate, Milltown, the barbiturates, the benzodiazepines – when Valium and Librium got discredited they were immediately replaced by a whole host of substitutes that are still touted as safe and efficacious, not so. They are all hugely addictive (worldwide sales of $21 billion dollars).
Then we have the list of sedatives and hypnotics. Then we come to the amphetamines. Speed was touted as an “up,” our first antidepressant, as well as an appetite suppressant for weight loss, with no need to diet or exercise. They were widely used by college kids for “all-nighters.” For the most part, they were used to get high, with massive addiction. Mental hospitals in the 1960s and 1970s were filled with amphetamine psychoses. Amphetamines were correctly discredited and pretty much disappeared from psychiatric and medical usage. But then a strange thing happened. A new medical-psychiatric genetic brain disease got invented: ADHD. And what was the treatment of choice? You guessed it. Suddenly, speed was safe again, non-addictive, no side effects, and it doesn’t generate psychoses anymore. I guess the significant percentage of inpatients suffering from amphetamine psychoses when I was a psychiatric resident was a figment of my imagination.
And then we come to the antidepressants; the old ones like Elavil, and the new ones, the SSRIs. Let me go into some detail here. Never mind that these psychoactive antidepressants barely perform better than placebo. Never mind that suppressed studies are finally coming out that show the antidepressants are proven to promote suicides and homicides in children as well as young adults. So many of the bizarre mass murders and tragic suicides of the last twenty years have occurred while taking antidepressants by adults as well as children. It is even hidden that Prozac is hugely addictive. Commonly, when someone tries to discontinue Prozac, he feels “depressed” again. The conventional thinking is that his “biological” depression returns, so he has to get back on the drug. And this is used to prove the efficacy and necessity of the treatment: Looks like our patient will have to stay on Prozac for his disease for the rest of his life.
What is actually happening is that the user has become habituated to the extra drug-induced supply of serotonin in his synapses. When the drug is discontinued, one’s natural ability to create serotonin is diminished and insufficient, due to biofeedback loops. Not only this, but users commonly have horrific withdrawal symptoms that are almost never publicized. An array of frightening neurological symptoms appear when trying to detox off this psycho-active brain drug—vertigo, lightheadedness, burning or tingling sensations in the skin, difficulty with gait and balance, blurred vision, tremors, twitches and restlessness. Sometimes there are hallucinations. Patients, understandingly, get terrified from these symptoms and conclude that something really is dangerously wrong with their brain. As a result they don’t dare to stop the Prozac. Thank God they are taking it in the first place and blocking these horrible neurological symptoms that are part of their brain disease. To discontinue an SSRI has to be done very slowly and carefully over the course of a year.
In fact, it is quite common that through drug tolerance, the serotonin-boosting effect attenuates, and its so-called anti-depressant effect diminishes. The expert pharmacological psychiatrists then add one or two more specially selected antidepressants into the mix, and an anti-anxiety pill for good measure, or maybe even an antipsychotic. Sometimes, we even have to shock some patients when their “disease” is deemed simply too pathological.
And the general public believes that we are operating out of firmly established evidence. Drug trials are performed where the standards are embarrassingly low – if 30% of an artificially established diagnosis is cured by placebo and the drug performs at 40%, this is considered proof of efficacy – 10% effectiveness. And these results are cherry picked since the host of failed trials are suppressed. 10% effectiveness, which is fraudulent, is not really a good standard for evidence. Our research in psychiatry should not replicate these criteria. These faulty conclusions generate a house of cards of fraudulent claims built on fraudulent claims, taken as truth. This is typical of ‘evidence-based’ psychiatry.
My final point regards the treatment for manic-depression and schizophrenia. Unlike all the other psychiatric conditions, there may well be a genetic, or epigenetic brain element. Drugs can be useful to contain the frightening disruption of the self, or of mania spinning out of control. However, drugs are not the treatment. Treatment is the human process of psychotherapy. Treatment is the human processes of care and respect. Treatment is community. Schizophrenia is a human problem. People are not things.
In the best tradition of science, one exception proves the rule. Once a theory is shown to be faulty, it is discarded. This never happens in the somatic psychiatry and pharmaceutical establishment. What kind of science can this be? How can the science be right when its outcomes are so wrong? A science that validates and promotes a lie is bad science.
History teaches that unless we learn from our experience, we are doomed to repeat it. The point here is that these practices are not only ineffective but harmful and destructive. We have a world on meds, and the proponents consider this a good thing. But it doesn’t have to be this way. There have always been good psychotherapists in all the professions. But never enough. And today, they have pretty much gone by the wayside. We need to renew the practice of psychotherapy. We need to understand in a clear way what the great human enterprise is all about, and give it our love and care.