Psychiatry Reconsidered … Once Again

Hugh Middleton, MD
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It would be a shame if Andrew Scull’s Madness in Civilization did no more than draw well deserved applause for his authorship and historical expertise, and a prominent place in the bibliography of madness. In immediate response to Philip Thomas’  MiA review of it, Slaying_the_Dragon_of_Psychiatry commented; “It is true that the questions ‘What should we do to the mad?’ or ‘What should we do with the mad?’ miss the point, but unfortunately the conclusion of this article also misses the point. Before we do any compassionate empathizing, we need to ask the question “What is madness”? More specifically, we need to ask the question ‘What is mental illness?’” (April 13th 2015). Twenty four hours later they added “It looks like I need to answer my own questions.”

My own copy of Madness in Civilization arrived last week, and it is great; comprehensive, brilliantly written, lots of colourful and many disturbing illustrations. Madness’ continuing story, “From the Bible to Freud, from the Madhouse to Modern Medicine” is told as never before, but there seems to be something missing, or at least I haven’t found it yet. I have looked through several of the reviews which have appeared in mainstream press; The Independent, The Financial Times, The Wall Street Journal, The Sunday Times and The Paris Review. Barely a systematic review of the literature but perhaps an indicator of what a wider readership is likely to be interested in and quite possibly take away from a reading.  All these vox pop reviews majored upon Scull’s vivid descriptions of how madness has been conceived and responded to through the millennia; the brutality and, in retrospect, the injustice of “treatments” and regimes of “care.” In several cases there was resonance with his oblique but inescapable commentary upon contemporary medical approaches, as no more “scientific,” effective or compassionate than their predecessors.  They were, however, no more successful than Philip Thomas in finding answers to Slaying_the_Dragon_of _Psychiatry’s questions.

I have the good fortune to be interested in this area because I have found it a rewarding and fulfilling way of earning a living. I haven’t suffered the pain and distress of being one with “mental illness” that I see in so many that come to me seeking help, meet at conferences or read about in pages such as MIA but it is not difficult to understand Slaying_the_Dragon_of _Psychiatry’s frustration. How can we better understand what we are dealing with here, and how might Andrew Scull’s recent contribution help with that?

To my mind what Scull has done particularly well is illustrate how madness has been with/in/alongside civilisation for at least as long as we can see as we look back into earlier times, but grasping what it is has been elusive, only ever partial, often clumsy, and frequently oppressive towards those identified with it. Although he takes trouble to distance himself from Foucault, the story he tells is also one of ways in which successive idioms have incorporated madness into their world view as a way of identifying what is and what is not “civilisation.”

Whether, as one might discern from a reading of Madness and Civilisation, the latter needs the former as an identifying boundary is the subject of another discussion. It could be one that develops Slaying_the_Dragon_of_Psychiatry’s question, and possibly helps to explain why madness has so readily provoked such intense and frequently brutal reactions down the years. What is timely, and in response to the wide acclaim Madness in Civilisation is enjoying, might be to focus a little more upon what this publication means for us, now. Whatever unpleasant experiences Slaying_the_Dragon may have suffered in their career as a mental health service user, these are unlikely to have been real medieval priests casting out demons, the physically harsh environment of an eighteenth century madhouse or a trans-orbital prefrontal leucotomy performed by Walter Freeman.

That is not to say experiences they may have suffered were not and could still be unpleasant, disabling and experienced as oppressive.  Slaying_the_Dragon’s comments, along with many others from people with experience of contemporary mental health services emphasise how often “modern” mental health services do no better than their historical counterparts. Scull has captured this well and the fact that he has been able to present it to a wide audience should be a game-changer. He reminds us it is misleading to argue that contemporary psychiatrists, other mental health practitioners, brain scientists and policy makers all have a good handle on madness, can deal with or provide for it and solve the problems it represents any better than their predecessors.

A century of medical psychiatry has achieved very little. Instead of being institutionalised, mad people are medicated in ways those giving the medicines don’t fully understand and with longer term consequences we have yet to find out about, their unconventional behaviours and experiences are invalidated in favour of conventional expectations and rather than being understood as who they are, they are “treated” into conformity. It may be that the relationship between madness and civilisation is such that some of this is inescapable, but if that is the case then don’t we owe a little more honesty to ourselves and those “civilisation” cannot accommodate? That might provide Slaying_the_Dragon_of_Psychiatry with something of an answer, even if it isn’t a fully welcome one.

Psychiatry Reconsidered is due to be published on May 27th. In it I have had a long hard look at the medical approach to madness, and why it really doesn’t work. Perhaps it is only through understanding why it has been attractive and yet still isn’t satisfactory that we can better understand what we are dealing with, and come closer to answering  Slaying_the_Dragon_of_Psychiatry’s challenging questions.

23 COMMENTS

  1. Madness in history ( before microbiology) might indeed have been caused by physical disease such as Syphilis.
    Vices and Virtues
    1 Lust Chastity
    2 Gluttony Temperance
    3 Greed Charity
    4 Sloth Diligence
    5 Wrath Patience
    6 Envy Kindness
    7 Pride Humility

    Before psychiatry there was vice and virtue. We can’t have one without the other.
    “In our fervor to medicalize morals, we have transformed every sin but
    one into sickness.
    Anger(5), gluttony(2), lust(1), pride(7), sloth(4) are all the symptoms
    of mental diseases.
    Only lacking compassion (kindness) is still a sin.” wrote Thomas Szasz.
    .
    Szasz missed Envy(6) and Greed(3) these sins run the world, money runs the world now, just like the company in the movie “Catch 22 (1970)”. Envy and greed are essential to a money based world.
    Over consumption of the planets resources. If your feel something is wrong, you are diseased.

  2. Hugh,

    Thank you for your community service; I will look for your book at the end of the month.

    Madness is emotional distress- the natural neurobiology of distressful experiences. Natural Psychology explains the paradox of how emotional distress is painfully irrational while simultaneously normal brain functioning. Natural Psychology identifies the scientific anomalies at the foundation of the popular paradigm and explains human psychology by solving these scientific failings with elemental neuroscience. It is published online at NaturalPsychology.org; criticism of its science is greatly appreciated.

    Best wishes, Steve

  3. Wow, fresh article. (Btw lacking compassion is the basis of many people’s politics, those who still have some are often derided as “liberals,” though I would challenge that categorization.)

    Anyway I await Dragonslayer’s response to this; meanwhile:

    Before we do any compassionate empathizing, we need to ask the question “What is madness”? More specifically, we need to ask the question ‘What is mental illness?’”

    I daresay that DS is not asking as a client for an expert professional answer to these questions, but is asking them from a somewhat rhetorical perspective, as I’m certain from previous commentaries that he (she?) recognizes the very existence of “mental illness” as a bogus contruct. And since “madness” is not a psychiatric disease category and is subjective I’m not sure why it would be considered as a relevant topic for highly scientific, medical minds rather than as the stuff of philosophy .

    Whatever unpleasant experiences Slaying_the_Dragon may have suffered in their career as a mental health service user, these are unlikely to have been real medieval priests casting out demons, the physically harsh environment of an eighteenth century madhouse or a trans-orbital prefrontal leucotomy performed by Walter Freeman. That is not to say experiences they may have suffered were not and could still be unpleasant, disabling and experienced as oppressive…

    Say what? ECT and waterboarding may on the whole be better than the rack, for that matter; is this suppose to imply progress of some sort?

    When I saw the heading “Reconsidering Psychiatry… Once Again” my first reaction was “Why again? Is there something we missed the first few thousand times?” Anyway, Dragon slayer, your ball (hope you don’t mind me calling you that, it’s just shorter)…

  4. “Those “civilisation” cannot accommodate?” The insufferable? Already I’m offended. What happened to tolerance? Well, there you go. I think people should have the right to be mad. Madness is not a right people have. They will lock you up for that, and it’s not even illegal. Figure that. I think there is something to Michel Foucault’s contention that the age of reason, the enlightenment, had something to do with our current desires to suppress unreason, in the form of madness, completely.

    Psychiatry has been deconsidered here, and I’m happy with that deconsideration. It saves money if nothing else. I see it as a field that has been growing by leaps and bounds ever since people found they could make money at it. Way back when, in England, there was only St Mary’s of Bethlem. Until the latter half of the seventeenth century there was space for no more than twenty mad persons at St Mary’s (aka Bedlam), and during most of it’s existence before this time the mad population at Bedlam could be counted on the fingers of one hand. Things have certainly changed.

    I would be happy to read Andrew Scull’s book if I can ever find the time to get around to it. I feel certain that I would find some things to disagree with him on. He has taken pains to separate himself from both Thomas Szasz and Michel Foucault, two very influential authors. I’m not sure there can be any thorough going understanding of error without indulging in error oneself. All the same, to lack that understanding is to alienate, and alienation can get you attention from the pseudo-medical authorities. What this attention rarely results in is an end of the alienation.

    All I can say is spare me your “help” because I do better without it. I have, in fact, seen that “help” kill people, many people. Just look at the statistics, and you will find out about people dying at an age on average 25 – 35 years younger than the rest of the population. If it was any other population, a big outcry would be raised, but because it is this unwanted population, how convenient. We will call it a “trade off” for some kind of “stability”, relatively speaking. There was a time when the pseudo-medical authorities weren’t so “helpful”, and people were living longer. I often think it would be a good idea to return to those times.

    • For me, what felt like mental chaos and confusion was caused by my dad making me feel totally powerless over my life and my mother enabling his abuse because of her fear. I grew up with the belief that I was supposed to be a certain way, according to their personal beliefs, and if I was not, then something was wrong with me, worthy of being shamed and demeaned. This was the indoctrination of my family, from the time I was born, so it was all I knew for a good long while. It felt normal to me, so I was not realizing that I was internalizing self-beliefs which were not serving me, other than to make me feel really badly about myself, for no reason other than I was not doing what my parents thought was “appropriate.” Random stuff, but it was their culture, and any deviance from this was scorned without apology.

      This is what caused me to feel mentally ill. I don’t apologize for that term, either.

      I worked with my story around this over the years, and found new perspectives which brought me relief and clarity, which, in turn, affected my reality in the most positive way. In that process, I learned to let go, forgive, move on, and grow my perspective to one of personal maturity.

      My father has since passed, but I healed with him before he died. With my mother, the roles have reversed, and now I am patient with her chaos. But it is very clear whose chaos it was in the first place. My mind is now clear, I’m grounded, and I consider myself to have healed from the mental illness which was, in reality, the family dysfunction due to child abuse and enabling. End of story.

      Psychiatry, medication, psychotherapy–all a waste of time, energy and resources which took me more off course than anything and for a while disabled me. Totally needless, other than to teach me a great deal about humanity, more than I could have imagined.

      I healed once I defected from the field altogether and stopped using these bogus ‘services,’ which amount to one big culture of social ills, purely, and turned to more sound healing support, found in alternatives such as energy healing, spiritual learning, body work, acupuncture, natural herbal support, grounding meditation, and taking full responsibility to what I bring into my life experience and relationships. That is healing.

    • Yes, this caught my attention, too. I believe the mental health field is the most financially exploitative operation in the history of the world. Mainly, because it is SUPPOSED to be about healing and alleviating suffering, and it does just the opposite, creating illness and actually causing suffering, so needlessly. And with such rich remuneration. How can people feel fulfilled when it is at the obvious and dire expense of others? That makes no sense to me.

      • Good points Alex. I’ve quoted C.S. Lewis before, but it bears repeating:
        “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

        • That is a POWERFUL quote! How much clearer can it get? As far as I can tell, it slays the dragon of psychiatry, because it calls it out perfectly, word for word. Thanks for posting it again, I hadn’t seen it before.

          I think this quote should be at the forefront of this particular movement, to eliminate the psychiatry-of-the-absurd due to its tyrannical mindset and oppressive practices, in the name of ‘healing.’ Moral busybodies, indeed! Love that, so perfect.

  5. “I haven’t suffered the pain and distress of being one with ‘mental illness’ that I see in so many that come to me seeking help, meet at conferences or read about in pages such as MIA but it is not difficult to understand Slaying_the_Dragon_of _Psychiatry’s frustration.”

    Apparently it is difficult to understand, because, like Philip Thomas, MD, you have almost completely missed the point. The reason why you have not “suffered the pain and distress of being one with ‘mental illness'” is obvious. You have been, and still are on the side that is inflicting the pain and distress. I do not fault you for this, because it is often done in ignorance. Repentance and forgiveness are available for all of us.

  6. “How can we better understand what we are dealing with here, and how might Andrew Scull’s recent contribution help with that?”

    The first step consists in not avoiding the question. The question is “What is madness?” or more specifically, “What is mental illness?” The reason why I had to answer my own question is that few have yet proven capable of answering the question correctly.

  7. “Whatever unpleasant experiences Slaying_the_Dragon may have suffered in their career as a mental health service user, these are unlikely to have been real medieval priests casting out demons, the physically harsh environment of an eighteenth century madhouse or a trans-orbital prefrontal leucotomy performed by Walter Freeman.”

    Is shaming, belittling and discrediting those who suffer part of your “rewarding and fulfilling way of earning a living”? Let me spell it out in case the irony of your statement is not clear to you. In psychiatry, the euphemistic term “unpleasant” may stand for a variety of tortures, and in many ways, modern psychiatric torture exceeds in severity that of medieval and medicine and early psychiatry. These claims are supported by any of the accurate, non-apologetic, historical records of psychiatry (see Szasz, Breggin, Whitaker, etc.).

    Next. let us analyze the euphemistic “career as a mental health service user.” Could anyone think of a more demeaning way to refer to victims of torture and abuse? Would we refer to a rape victim as one who has had a “career as a forced-sex service user”? Would we refer to a murder victim as one who has simply benefited from their “career as a life-ending service user?” Perhaps many Africans of early American history experienced a distinguished “career as slavery service users.” Did the Jews that were consumed in by the fires of the Holocaust just finish up their “career as Nazi gas chamber service users”? I think not.

    The phrase “mental health service user” is not only demeaning, it is completely illogical. The notion that there is any such thing as a measurable “mental health” is almost as absurd as the myth of so-called “mental illness.” This conundrum is exacerbated by applying the misleading term “service.” Let me be absolutely clear about this. The psycho-pharmaceautical industrial complex does no service except to its own bank account. The oppressive apparatus of psychiatry serves only its own guild interests and the wallets of its chieftains. If that is unclear, please refer to Robert Whitaker’s and Lisa Cosgrove’s most recent book “Psychiatry Under the Influence.” Last of all, let us consider the term “user.” The vast majority of innocent victims who are sucked into the psychiatric machine of oppression have no idea what they are “using.” They are not using anything that helps… they are being used. The phrase “mental health service user” needs to be stricken from our vocabulary. Let it become a relic of the religion of psychiatry, along with the myriad other harmful terms. Szasz was indeed right when he concluded that “In the animal kingdom, the rule is, eat or be eaten; in the human kingdom, define or be defined.”

  8. Finally, I’ll address the arrogantly dismissive conclusion of the paragraph, “these are unlikely to have been real medieval priests casting out demons, the physically harsh environment of an eighteenth century madhouse or a trans-orbital prefrontal leucotomy performed by Walter Freeman.”

    “Medieval priests” were saints in comparison to modern psychiatrists. The “physically harsh environments of an eighteenth century madhouse” were 5-star hotels in comparison to the kind of sophisticated, pseudo-scientific centers of torture that have acquired the euphemistic title of “hospitals.” The trans-orbital prefrontal leucotomies of Walter Freeman were love taps compared to the excruciatingly painful chemical lobotomies that are the direct result of forced psychotropic drugging. Medieval and early psychiatric torture was horrendous and evil, but it wasn’t always as hidden as it is today. Now the torture that takes place is called “treatment” and the oppression is called “care.”

    • What I noticed about all that is how he jumps from the late 1700’s to the 1950’s; Freeman was much more part & parcel of modern “biological psychiatry” than of the 18th century madhouses. In any event, torture is torture, from the ships of fools to Guantanamo.

  9. “That is not to say experiences they may have suffered were not and could still be unpleasant, disabling and experienced as oppressive.”

    Notice the clever turn of phrase “experienced as oppressive.” Psychiatry is as “unpleasant” as poison, “disabling” as abuse, and “oppressive” as a totalitarian government. Oppression is experienced as oppressive by those who are legitimately oppressed. The oppressors obviously don’t experience the oppression in the same way. In fact, sick though it is, some oppressors seem to enjoy the art of oppressing, and not just for the sake of financial benefits.

  10. “Slaying_the_Dragon’s comments, along with many others from people with experience of contemporary mental health services emphasise how often “modern” mental health services do no better than their historical counterparts.”

    Am I still failing to be clear? There is no such thing as “mental health services,” and the modern version of psychiatry is, if anything, more insidious than its historical counterpart.

    “A century of medical psychiatry has achieved very little.”–

    Au contraire. A century of medical psychiatry has achieved the abuse, torture, and murder of thousands upon thousands of innocent people, including children, the homeless, and the elderly. It has accomplished what is perhaps the greatest hoax in history by convincing an entire society of the myth of mental illness and the false diagnosis of chemical imbalances. It has achieved the great status that is set out to achieve, at the expense of human lives and much misery. Medical psychiatry has accomplished more evil than our word processing machines are able to write.

    • And, not to be ignored, it has convinced the critical mass which could make a difference that people’s predictable reactions to objective social and economic oppression are not “symptoms” of a toxic system, requiring political solutions, but individual aberrations for each person to privately obsess on, be ashamed of, and suppress. Defeat yourself, not capitalism.

  11. “That might provide Slaying_the_Dragon_of_Psychiatry with something of an answer, even if it isn’t a fully welcome one.”

    I appreciate the time and the effort that it took to attempt a response, but your article completely avoided the questions: “What is madness?” and “What is mental illness?” Civilization hangs in the balance. Those who claim the power to define “madness” or “mental illness” also assert their power to oppress. Is it any wonder that the prophets of old, and even Christ Himself were persecuted, mocked, killed and crucified? They spoke the truth, and for this reason they were called “mad.”

    The answers to the questions: “What is madness?” and “What is mental illness?” are found in the writings of Thomas Szasz. Mental illness is a myth of epic proportions, and as long as the public remains blinded to this reality, the oppression will continue.

    I urge all who read this to read “The Myth of Mental Illness” and then to join in the noble quest to Slay the Dragon of Psychiatry. Psychiatry does not need to be “reconsidered.” It must be abolished.