Once again, I just finished another consultation with someone from out of state who was desperate to find a therapist who he could talk to. He didn’t want to be pigeon-holed into some DSM-5 reductionistic diagnosis. He didn’t want psychiatric drugs. He was desperate to find a psychiatrist who would understand him, who he could relate to, and could treat him with real psychotherapy. There should never have been a reason for me to consult with anyone from out of state. Unfortunately, the cynical and fraudulent takeover of psychiatry is all but complete. How many real psychiatrists are left?
How did this happen? Over the course of my career, I kept my head down and devoted myself to my craft, psychotherapy. I was certainly aware of the collusion between the APA and the drug companies. But as recently as ten years ago, I honestly did not know that things had really deteriorated this far.
Apparently, Dr. Jeffrey Lieberman and other like-minded psychiatrists decided that psychoanalysis had too much power, and they wanted to transform the APA once again to the tenets of somatic psychiatry. 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 acted directly on the brain, always with violating and destructive outcomes.
Somatic psychiatry originated with seizure therapy, or its first modern incarnation, insulin shock therapy (IST). It actually had its roots in the sixteenth century and was used psychiatrically around the time of the American Revolution. It was refined in 1927 into insulin shock therapy, when insulin was used to induce seizures as a treatment for drug addiction, psychopathy, and schizophrenia, with claims of a 50 percent remission rate. Papers were published in the American Journal of Psychiatry, starting in 1937. IST was widely used through the 1940s and 1950s. Its founding etiological principle was the (false) idea that seizures were the opposite of schizophrenia. Induce a seizure, and you balance out psychosis. In the 1930s, a more refined scientific explanation was developed for the (phantom) curative power of seizures. Its science proclaimed that psychiatric problems came from the autonomic nervous system. IST was said to work by blocking the nerve cells of the parasympathetic nervous system, thereby intensifying their tonus and strengthening their anabolic force. This restored the nerve cell, and the patient recovered. The corollary theory was that patients were jolted out of their psychiatric condition.
Next, we have lobotomies, originally called leucotomies. Lobotomies came onto the scene in the 1930s, having been invented and promoted by Antonio Egas Moniz. When I was a psychiatric resident, lobotomies were still fresh in psychiatric memory. The practice had only ceased in the early 1960s, after over twenty thousand people received this “treatment.” Let’s see … what was the science? The source of psychiatric problems was located in the brain, specifically the prefrontal cortex. The treatment of choice, then, was to ream out the prefrontal cortex with an ice pick. Respected MDs had a miracle cure and were the vanguard of the field. Science proved that lobotomies cured not only schizophrenia but anxiety, depression, low self-esteem, obsessive/compulsive disorder, and the unwanted behavioral problems associated with mental retardation (this is code for sexual behaviors). It was respected and celebrated in the psychiatric literature and validated in journals with documented studies and peer-reviewed scientific evidence. Lest you think this is an exaggeration, Moniz won a Nobel Prize in 1949 for his great and wonderful discovery.
Eventually, the validating follow-ups were shown to be fabricated and deluded, with self-promoting lies and half truths. Only after a great deal of harm were they debunked. And the ice picks were thrown into the trash heap of psychiatric history. We need to add that after lobotomies gradually attenuated, no one stopped and said, “What in the world did we just do?” How could sticking an ice pick in someone’s brain ever have been even a remote consideration? What was going on that such a grotesque medieval mutilation was actually adopted as a good thing to do? And how could it have been publicly and professionally embraced? However, as always seems to happen, amnesia quickly set in, and we forgot the brutal inhumanity that was so recently celebrated. And the considerable body of discredited scientific validation was never scrutinized for its contribution to and for having promoted such harm. Instead, science moved on to support the next somatic treatment in exactly the same way.
Next, we have electroconvulsive therapy (ECT), which came along soon after IST, in 1938. ECT was still a part of the curriculum in my own psychiatric residency in 1971. Entire psychiatric hospitals, built exclusively for ECT, were still operating, with no empty beds. Scientific studies and respected journals provided documented validation for placing electrodes on patients’ heads and applying huge jolts of electricity to generate seizures. Apparently, the jolt theory had gained traction. So we shocked the brain, instead of reaming it out. How humane. In addition to everything else, ECT also was touted as a cure for depression. It was allegedly proved that ECT was a safe, effective cure, with few, if any, drawbacks. The resultant memory loss not only was initially downplayed but was trumpeted as being therapeutic. (By the way, drugs are being developed today to chemically erase memories with the idea that this is therapeutic for trauma—same thing.) Later, under public pressure, ECT was refined to cut down on memory loss. The history of electroconvulsive therapy followed the same trajectory as lobotomies. Eventually, ECT showed itself to be the ineffective and violating practice that it is. But don’t get overconfident. Incredibly, in recent years, ECT has made a comeback and is being promoted once again, when its progeny treatments, antidepressants, don’t work.
Finally, we come the current incarnation of somatic psychiatry – neurobiological psychiatry, and its so-called treatment—drugs. Psychiatric drugs are next in the lineage of “treatments” whose focus is to act upon the physical brain. History is repeating itself. Our contemporary science has now apparently proven that human problems come from genetic or developmental neurobiological disorders of the physical, anatomical, biochemical brain. The somatic treatments for these neurobiological, genetic, synaptic hormonal neurotransmitter diseases are brain drugs—psychoactive drugs.
In one generation, the APA, in collusion with the drug companies have destroyed psychiatry. The American Public has been sold a bill of goods. People actually believe that human struggle is a brain disease. It is now taken as fact that there is a chemical imbalance in the brain and psychoactive drugs is just what the doctor ordered. We can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; the fictitious ADHD with, of all things, amphetamines; insomnia with benzodiazepines, and other bizarre psychoactive drugs; Likewise the belief is that schizophrenia and manic-depression should be treated with drugs (In my experience, there may be a place for the use of some drugs – In schizophrenia when the self and its primal play flies apart, it generates a state of terror, the dimensions of which are far more powerful than regular anxiety. The resultant terror/rage is the worst and most unbearably frightening state of all potential human experience. And likewise, in manic-depression the central feature is that feeling, which is ultimately a rage state, cannot be contained by the ruptured play. It spins out of control without limits. However, drugs are not the treatment. The issues are not some brain thing, but human issues. People with schizophrenia and manic-depression are no different from you and me. The appropriate treatment is psychotherapy which deals with the human story.)
The real source of human suffering is not, nor ever has been, the brain. The issues are in the person, the human being, in the context of damage to the play of consciousness, created by deprivation and abuse in the formation of our character. My life’s work has taught me that the art, the science, the discipline, and the wisdom of psychotherapy attends to this damage. There are no miracles and no shortcuts, as drugs, like the other somatic therapies, always promise. Never mind the harm done. We have repeated the same mistakes over and over again, and we are doing so today.It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping $70 Billion a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition. I am well aware that the history of psychotherapy is checkered. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of responsiveness to our patients. Although my own roots are 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 in the first place. All psychiatric symptoms are the expression of our problematic characters. By exploring, within the safe emotional holding by the therapist, we heal our unmourned pain and our psychiatric symptoms dissipate. We have thrown out the baby with the bathwater. There are many people who want psychiatry to be destroyed. I am not one of them. I know how valuable, life saving, and rewarding good psychiatry can be. Psychotherapy is the real item. We must get back to it. It fosters the recovery of one’s authenticity and the capacity to love. This is the source of all psychiatric struggles. It taps into the heart of life’s mysteries and wisdom
Although I agree with this piece as far as drug treatments are concerned, I cannot say there is much to be gained from traditional therapy either. My last therapist did not push pills. I was welcome to try them if I wanted. Unfortunately, the only other therapy she had to offer was CBT.
Instead of a broken brain I was told I suffer from a dysfunctional personality. Only if I start meditating, keeping a gratitude journal and replacing all my negative thoughts with positive ones, I could become the person society wants me to be. She would often quote Depak Chopra and Eckhart Tolle. All this new age junk made it feel like I was billing my insurance to talk to a psychic not a psychiatrist, with the DSM replacing astrological signs. After weeks of no improvement I was told that it was my fault because I wasn’t really making an effort. While they don’t actually say “Snap out of it” that really is the general idea of CBT. You are broken, reprogram yourself.
During my first appointment I begged her not to let me slip through the cracks. I told her that I do not have a single friend or family member who would help me. In spite of all this that is exactly what happened in the end.
There is no help for people like me. We just suffer until we die. I have finally come to terms with the fact that my failures in life are not my fault. My personality is not a disorder. There is no chemical imbalance in my brain. I am just as worthy as every other being on this planet, even if society has decided to rule me subhuman and unworthy. I will not be made to blame myself anymore.
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I am glad that you are not blaming yourself for your pain…Life is hard and I believe that healing and growth take as long as they take and happen in many different ways…mental health providers should be humble…life is a mystery and mental anguish always deserves respect and patience. No one can claim to have another’s answers…we can only accompany others on their paths so they are not alone…wishing you peace and healing…
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Ramona, your comment moved me greatly, but I am glad that you recognize your worth and refuse to blame yourself. You are obviously very intelligent and articulate, and I hope that you will find like-minded people who appreciate you. Please do not give up and resign yourself to a life of suffering.
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I totally agree with you. While getting “talk therapy” is clearly less damaging than drugs and ECT in most cases it’s far from beneficial. It’s the same message pushed on a person – you’re wrong, defective, broken and how you feel and react is abnormal. It places the blame and the responsibility on people who usually have been abused and traumatized. We need social change and justice and not being told to suck it up (now called “resilience”) in one way or the other.
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Hi Robert,
lovely post. There certainly is such a thing as good psychiatrists and good psychiatry, though sadly it does appear to be disappearing. As you brought out clearly, the practice of psychiatry should be primarily the practice of psychotherapy, as human suffering, related to various aspects of societal dysfunction is the main cause of distress in almost all the people we see. I read psychiatric research, and I am usually appalled as the research appears to have little relevance to a real life clinical population. How often do you see “an anxiety disorder” or a “major depression”? I don’t even know where they find people who have a single “disorder” with no complex personal issues for research studies. All the people that I treat have complex issues that require proper attention and time. There is no short-cut to treating real people. One can’t just pay attention to symptoms, though in my experience if one attends to the underlying issues, symptoms tend to disappear fairly quickly. Psychiatry has almost been destroyed, though it is possible that both people in distress and many therapists are getting fed up with all the distortions and self-serving institutions. It’s encouraging to read your words.
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Seems like rose colored glasses in a way. I’m not saying therapy can’t help anyone but you appear to be saying that focusing on a person’s health can’t help the mind either, that no issue might be a health issue which seems kinda ridiculous.
Have any of these professions ever had a good reputation ? Who isn’t really a nutcase ? Freud, Jung, Skinner,etc etc.
When hasn’t there been nutcase psychiatrists engaging in some kind of eugenics ? Wandering around the country performing labotomies or shocking people ? “Deep sleep therapy” and so on and so on.
Has psychiatry ever really been a noble profession ?
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Good point. It’s not like there has ever been a golden age of psychiatry when they were not abusive or they managed to get a single thing right. This is a failure from the get go.
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Hi. I’m a GP in a rural area and I treat many patients with behavioral issues, of course referring those I deem to be a danger to themselves or others to the few psychiatrists located within a hundred mile radius or for inpatient evaluation. Many of my patients also have profound social issues and physical comorbidities. Nevertheless, they more often than not report that thanks to the pharmacological therapy their moods are stable and fairly upbeat, their anxiety, racing thoughts, voices, sadness, etc. improved. Although my results are anecdotal, still I am not convinced to radically change my practice on the strength of your article. In addition, I would need to see some double blind studies where any modality, whether pharmacological, behavioral, or psychotherapeutic leads to true happiness and joy.
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Many people who now view antidepressants and minor tranquilizers unfavorably started off as patients who got relief initially from psych drugs. They are all a little bit stimulating, but we soon habituate. Problems come up, like weight gain, feeling dead inside, losing sexual feelings, inability to care about others, lethargy, somnolence, or being angry and irritable. Then, the withdrawal. Some people can’t hack it after a few days they go back on drugs or start new ones. those people collect on sites like http://www.crazyboards.org/forums/ nd keep trying new drugs. Some are on 6 or 7 drugs.
Other people get through it in a few weeks, and some people suffer for years. It’s hard to believe and easy to think it’s neurosis or malingering. People in that boat connect on survivingantidepressants.com
Benzo people have their own special torments. http://www.benzobuddies.org/forum/index.php
There also Facebook groups & Yahoo groups.
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I couldn’t agree more.
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Hi/
I do agree with you that there is a place for medication, and certainly medication if used properly can help people. We should not be withholding pain relieving medication from people in distress, especially when other resources may not be available. I have been teaching psychopharmacology to therapists for over forty years now. An important issue is how to use medication in minimal doses when necessary, but to not distort the reality of the meaning of diagnoses and the downside of medication. The larger issue in Robert’s article is the way modern psychiatry is hijacking the understanding of human suffering and reducing everything to a simplistic and erroneous biological model. In general, the results achieved by this new model of psychiatry are poor, with many people suffering from the ramifications of inadequate treatment and serious physical and emotional side effects. It is often, though that individual practitioners like yourself do find through their clinical experience what can actually be helpful to people, separate from what may be most marketed. If you would like some practical tips on using psychiatric medication, feel free to contact me.
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“Nevertheless, they more often than not report that thanks to the pharmacological therapy their moods are stable and fairly upbeat, their anxiety, racing thoughts, voices, sadness, etc. improved.”
I suggest you prescribe them homeopathy or herbal tees (telling these are the new cutting edge drugs) and see that most of them will feel better either way. It’s called placebo effect. For the rest temporary tranquilization may seem helpful until they come back with 10x more mental problems and physical issues on top of them a few months later. Have fun withdrawing them from the drugs then – I’m sure they will also have amazing time with that (just to be clear – I’m being sarcastic).
When it comes to actual studies it’s pretty clear that anti-depressants are not really anti-depressive more than a placebo, anti-psychotics are major tranquilizers (sometimes rightly called chemical lobotomizers) which in the long term lead to cognitive decline and hypersensitivity psychosis, amphetamines are… well… amphetamines, I don’t think one needs more information and benzos are addictive and cause terrible mental and physical side effects. I’m sorry to tell you but you’ve got no idea what you’re putting your patients through prescribing them these poisons. If you don’t believe try to take some anti-psychotics and see how awesome that feels or give yourself a few months of benzos and then try to stop (just to be clear: don’t really do that, it’s torture and I don’t wish that on anyone).
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This is a good article, but I also agree with the people who say there is no hope for someone like me. I hate the antidepressants!! I have tried almost every single one of them to only suffer even more from the side effects and then when I stop taking them I go through months of hell from withdrawal. So NO it has not stabilized my life and made me feel better. My mom has been on them for over 10 years and she is afraid to stop taking them, every time she tries she can’t handle the withdrawal so she goes right back on. In our case, it is no better than cocaine….it makes you feel like it brings you up and then the side effects kick in and you want to stop but then too late…you have to take them so you don’t suffer the withdrawals. They may not be addictive, but in a sense they are if they change who you are once you take them and then you can’t stop taking them without falling apart. Let’s just say I was just somewhat anxious and depressed after I had my son….I start taking those nasty drugs and guess what….I became AGORAPHOBIC!!!! I am afraid to leave my house….that was 4 years ago, I have tried other meds during that time and I am even worse….they are poison. But, here is the kicker…I have NO Psychologist or Psychiatrist within two years of me, all I have are social workers…I go to see them and they can’t help! I pay them money to talk to me like a friend. SO I have no doctors even near me who care, only people who want to push the drugs and make my brain into soup. I miss when I was just a normal mildly anxious depressed person who could function before the meds….now I am a basketcase….thanks antidepressants for ruining my life!!
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I mean to say no psychologist within two hours of me not years.
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I’m not sure what country you’re in, but assume you must live in a quite rural area? Sorry to hear you’re so far from help.
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I am sorry for your struggles. Antidepressants are addictive. There can be horrible effects of all kinds from discontinuation. And people end up believing their initial symptoms return. To stop medication, one has to do it very slowly over the course of a year. And still it is problematic. Unfortunately it should be done under the care of a psychiatrist. I wish you could find someone to work with, even two hours away, if just to deal with discontinuing the drugs.
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I agree, chick, you’re still young and I think it’d be best if you had even your local PCP help you wean off the antidepressants. Personally, I had the symptoms of antidepressant discontinuation syndrome misdiagnosed as bipolar by a bunch of stupid doctors, so Google that and read about what are some of the common symptoms you should expect.
As to someone to talk to, start a journal instead. Write down everything you experience. Journaling is a wonderful way to get everything out of you that you need to get out, without having some person who doesn’t know you judge you harshly or further misdiagnose you as you’re going through a terrible, mind altering experience. And it may be your inspiration for a book some day, that could help others.
I also recommend eating healthy, drinking lots of non fluoridated water, and exercising religiously. Getting in shape makes everyone feel better about themselves. I found upbeat music, gardening (being in nature), biking, dancing, and painting (any creative outlet) to be helpful also. And you might even suggest your mom and you wean off together so you have a comrade as you go through the withdrawal.
I understand Peter Breggin has a book out on withdrawaling from the drugs, definately inform yourself, and whomever is helping you wean off the drugs, prior to doing so however. Best of luck to you, I’m not saying it will be easy or fast. I still have brain zaps 15 years later, and imagine at this point they’ll never go away, but if I get a headache I can brain zap it away in an instant. My current PCP thought that was interesting. Good luck, oh, belief in a higher power also helped me.
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Dr. Berezin,
Are you able to explain how your theories are less dogmatic that psychoanalytic ones? “All psychiatric symptoms are the expression of our problematic characters, ” sounds somewhat dogmatic to me. Also, assuming this way of working is helpful, why is medical training considered a prerequisite? In other words, in what way is this specifically an endorsement of psychiatry as opposed to an endorsement of a psychotherapy that could be as effectively offered by someone who does not have medical training?
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Sandra,
Of course psychotherapy could as effectively be offered by other’s without medical training. I was however, writing about psychiatry in this post. I have addressed that elsewhere. I cannot easily address the dogmatic question. In blog’s I have to resort to shorthand. I don’t mean to seem to be selling the book, but if you are genuinely interested as to whether the ‘psychotherapy of character’ is dogmatic, I would hope your would read it. I’d be happy to discuss it.
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an observation based on common sense: most of people who have around a person with mental disorder know the theory that mental disorders are ”same like diabets”; still, those people, when reacting to it, do not behave same as it is a disease same like diabet. This common sense and basic observation raises further questions: why? I think it is because in their instinct, people ”feel” that IT IS NOT like diabets or like another medical disease. It is not a matter of educating people and explaining them thechemical imbalance theory – people will always be unable to react like it would be a medical disorder. Further – which are the measurements of the imbalance; is there any tool of measuring the imbalance of the brain, an imbalance unseenable in most of the cases? And which is the amount considered being a ”balance”? Further: it is enough to look at the history of mental disorders – psychiatry has been trying and trying to prove the reality of some arbitrary concepts – a reality they’re struggling to create. Those concepts have never been validated, their original meaning is changed -like nicknames and their proof in any possible measurement – it does not exist. For the cases where the proof exists, it still falls under the incidence of unproven concepts – precisely for trying to prove the validity of that concepts and of ”the treatement”. In a nutshell, nobody with a mental disorder had been happy before the mental disorder occured.
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Some of these ideas are dogmatic, but they are not as harmful or misleading as common psychiatric lies like “schizophrenia is a brain disease”, “depression may be caused by a chemical imbalance”, and “mental illnesses have a genetic and biological basis and run in families.”
I think your point about medical training being unnecessary is absolutely correct. Working with severe emotional distress does not require medical training, thus what Berezin talks about could more properly be referred to as Psychotherapy or just helping people, period.
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Dr. Breezing,
I agree that I should spend more time with your ideas before drawing fir. Conclusions and I will try to do that.
Bpd transformation,
Your idea that some ideas are more harmful than others is stated as fact when it is a hypothesis – perhaps true, but hypothesis nonetheless.
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Hi Sandra,
You points are well taken. I am writing a piece now for MIA on the value and shortcomings of psychiatrists and a medical education. Clearly in the mental health field, and in psychotherapy having people who come from various education and life backgrounds is very valuable, though I do think that the medical profession should be able to have particular value. let me address quickly for now some of the points I intend to write about. Medical education is highly clinically based. By the time a psychiatrist has finished medical school and residency, one will have been involved in the treatment of hundreds of people. As medical students, we see life coming into the world and leaving it. Don’t we all remember our first delivery and first death? I remember very clearly as a beginning third year student the patient who died when I was on call, and having to fill out the death certificate and call in, and talk to the family. We all are exposed to all manner of human suffering. In psychiatric residency we assess and treat many patients with all different kinds of problems. In my program, and probably Dr Berezin had the same experience, we had comprehensive psychotherapy training and teaching throughout the program. I remember how psychology PhD interns would be carrying 2-4 patients for their rotation in the same service that I would be responsible for 10-15 patients. The experience in medical school and residency should leave someone better trained and having more empathy for patients due to the intensity of the training. It is unfortunate that instead the training can leave many doctors distancing themselves from human emotion and arrogant about their knowledge. There are many other possible advantages of a medical education for the mental health field, but some of the same aspects that lead to advantages can also cause serious limitations.
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“The experience in medical school and residency should leave someone better trained and having more empathy for patients due to the intensity of the training. It is unfortunate that instead the training can leave many doctors distancing themselves from human emotion and arrogant about their knowledge.”
I think it’s only natural an human. Experiencing death and suffering every day leads to emotional blunting and withdrawal as a survival mechanism. That’s one of the reasons why I don’t believe in the psych professions. This is not something you can train yourself to and you can’t bond with that many people in any meaningful way. People in emotional distress need real relationships not “professionals”.
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Yeah well, in this way of thinking, almost everything would be a hypothesis. There are few certainties in life and sometimes we have to go with common sense and what we know from experience to be true, as you noted in your recent article. As common sense and experience tells me that those things I quoted, which many (not all) psychiatrists do say, are more harmful and misleading than the various assertions Berezin made about how psychotherapy / understanding emotional problems through relationships helps people.
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I certainly agree with you that being a good therapist does not require medical training. In my experience people need a certain empathetic quality to be a good therapist, and that can’t be trained. On the other hand, a medical training “should” give one the following abilities that can add to the perspective from people of different trainings.
Medical doctors should be able to:
Read scientific research and distinguish between clinically valuable findings and simple statistical findings.
Understand a vast array of human suffering.
Understand the interplay between biology and the mind in a complex manner.
Know when an emotional issue may be related to a physical disease.
Know that every treatment may have a down side.
Know that a patient’s needs should always take priority.
Know that we can never be certain and need to be humble.
Know the first rule of medicine “Do no harm”
Doctors are (or should be) trained to understand all these points. We should be asking ourselves, not why we might need medical professionals in mental health, but why so many doctors who work in this field have forgotten their basic training.
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If you don’t mind, I’d like to add a couple to that “medical doctors should be able to” list:
Be aware of long run adverse withdrawal symptoms of commonly prescribed drugs (like antidepressants).
Be aware of ADRs of drugs, and check the medical literature, prior to telling a patient his / her ADRs are due to a “disease.” And be cognizant of the fact the medical literature is quite incomplete / evolving, and sometimes completely incorrect, due to the pharmacutical industry’s shenanigans during, at least, the past several decades.
Be aware of the fact that all patients are different, therefore each will react differently to different drugs. So a “gold standard” treatment for any disease, especially the subjective unprovable “disorders,” is illogical and inappropriate.
Check for possible drug interactions between drugs, foods, and supplements the patient is taking, or has taken within the past TWO YEARS, prior to prescribing any new drug or making any diagnosis.
Give informed concent to all patients, both in regards to the diagnoses you’ve strapped them with, some for a supposed lifetime, and in regards to the ADRs and withdrawal effects of all drugs prescribed.
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“Psychotherapy is the real item. We must get back to it.” Of course, it is only the real item if one can access a therapist who has the skills, abilities, motivation and commitment to make a difference otherwise it is little better and no less damaging in its own way then medication, ECT and the like. Where medication and ECT were (are) promoted as alternatives superior to therapy how can we now insure that persons who seek out therapy find it to be an effective alternative to medication and ECT?
Finding a therapist who can make a difference should not be the consequence of the fortuitous intersection of finances, location, modality, practitioner skills and abilities, patient needs and wants, the existence of a therapeutic relationship, etc. For so many this intersection never occurs and the alternative to medication is no alternative at all.
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You write: “In one generation the APA, in collusion with the drug companies, have destroyed psychiatry.”
From the history you described of psychiatry before the collusion with drug companies, there was not much there to destroy.
It seems obvious that psychiatry destroyed itself long before this relationship.
The glory days of psychiatry… What glory days?
Duane
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Also, I find it interesting that there never seems to be concern about the costs of sessions when it comes to psychotherapy, which can easily range from $100 – $200 or more each session.
MIA is packed with anti-capitalists when it comes to drug companies; the economy in general, but never a peep about this. I can only assume that these (hardly cheap) sessions need to be paid for with tax money, or insurance companies – in other words, someone else, or all of us (both, actually).
I have no problem with free markets, but many others on this site do. Where is the outrage with the “profiteers” in psychotherapy?
No medical equipment, no large medical staff, no large overhead; a person can put up a shingle and bill a couple of hundred bucks an hour, without a peep from the collectivists… Interesting.
Duane
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Excellent points, Duane. Like you, I’m not an anti-capitalist and do not think the “creeping socialism” we’ve witnessed in our country over the past fifty years or so is a good thing. Even though I detest collectivism as it’s manifested in totalitarian states over the past century, i increasingly believe that a loving, very supportive community is very conducive to real healing for those suffering from extreme emotional and mental distress. “Bear one another’s burdens, and so fulfill the law of Christ.” In such a community, perhaps the expensive psychotherapy would not be necessary…or at least less so; or the community of caring friends would pull together to cover the expense, sort of like the Amish do in building a barn for one of their own. One other thing on this: Here in New York State, insurance covers psychotherapy with the same co-pay as medical conditions, due to “Timothy’s Law”.
Russ
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I just checked and many other states also have “mental health parity” laws that would at least partially mitigate the cost of psychotherapy. Unfortunately, you probably need some kind of a mental illness diagnosis, which could open up a whole other “can of worms”.
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Robert, Interesting article which shows the divide between psych survivors or those trying to become survivors with clinicians and docs.
What I have seen as both a licensed professional and a psych survivor is a huge downward spiral in the quality of all the helping professions. The best and the brightest are on Wall Street doing algorithms to better track our consumer lives.There is also a problem with the inability of a true peer movement to take place sot hat those who have been helped are very reluctant to own it and it crease and undertow of double binding situations.
That being said, I have had a hellish time with receiving help for my traumatic experiences that were wrongly diagnosed.
Trauma can be the source of emotional distress and I am not willing to commit about anything else. But if the trauma can be documented then it must ethically be addressed.
This does not happen often . One needs a skilled therapist to deal with the effects with past trauma. One effect being the sheer inability to put into words the actual trauma.
This is not happening. Folks are given sometimes high priced quakes and fakes or those with good intentions but little or unimpressive intellectual depth and in depth skill levels.
As in every profession and job these days its all about the bottom line and profit. Not all because of greed but so many just are getting by and in the getting by we are losing.
I would strongly suggest everyone in the MIA community not only read Bessel Van Der Kerk’s work but also “”The Evil Hours” by David Morris. In his book I first came across the phrase post traumatic growth. Yes it can and does happen. Not by therapy alone, or meds, ( for those that say they work) but by a conscious choice by the traumatized person to go beyond. Not all are able to do this but I wonder if we had a more caring and compassionate world if more could be helped. I also liked Bessel’s idea that we all are traumatized in some way shape or form.
This shouldn’t be a two way conversation between those with alphabet letters after their name and those of of who have literally been in hell.We need an ongoing dialogue with give and take back and forth for more than just one or two postings.
Evan’s post was enlightening and sad at the same time. Same old, same old. I am thinking maybe we should look into SNAP which works on the sexual abuse within the Catholic Church. They deal with legal folks, helping professions, and survivors, and family members all together. They actually meet face to face in various locations. The power structure is basically the same secrecy and avoidance and continual need for control and inability to truly reconcile. The story of what the advocates have gone through is chilling in and of itself.Robert Whitaker’s concept of corruption certainly fits nicely.Not easy and will take decades to begin to really move things. But how can we not?
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Re: “… We are all traumatized… ”
Sounds a lot like “30% of people have a mental illness.”
Which is why I have so little confidence in either psychiatry or psychology.
How did people historically overcome trauma before the professionals? Maybe we ought to look closely at those tools.
Duane
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I’ve met with some SNAP people a couple times, since I was drugged to cover up child abuse for an ELCA pastor, and that religion’s dirty deeds in recent years were written about in this 2007 book. Check out the chapter on evil.
http://www.amazon.com/Jesus-Culture-Wars-Reclaiming-Prayer/dp/1598868330
SNAP, from my experience, really focuses on getting the Catholic Church primarily. I have medical evidence of the abuse of my child, and they were not able to offer me a lawyer. I did go to a couple meetings, and met with other clergy abuse victims, however.
What I learned is the Catholic Church is being more upfront and honest about their pedophilia problems, at least than the ELCA, which is still completely denying the problems. But the Catholics are still utilizing what a Methodist pastor confessed to me is the “dirty little secret of the two original educated professions.”
The two original educated professions are the religions and medical communities. And, historically, and still today their “conspiratorial” “dirty little secret” is to utilize the psychiatric industry to cover up child abuse for the religions and easily recognized iatrogenesis for the incompetent doctors.
At the second SNAP meeting I attended, a lawyer and his wife told their story of how the Catholic Church confessed to the abuse of their daughter, refused a financial settlement, and insisted the only compensation they’d offer was psychiatric care. The couple was so confused because their daughter had been put on antidepressants, and turned into a bipolar patient. I explained to them that was common, and recommended Whitaker’s “Anatomy.”
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My point is my experience implies SNAP seemingly has it’s hands full with their current mission. And you are right about the similarity between the religions’ abuse of power and the medical communities’ abuse of power. And they are related, and based upon the same “dirty little secret.” What’s most sad is that when one looks into the actual medical research, and effects of the psychiatric drugs, it’s highly likely the most common etiology of “schizophrenia” in our society today is related to the medical and religious “dirty little secret.”
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Wow, wonderful useful article. I find I am referring more and more people to http://www.madinamerica.com just for this kind of intelligent courageous article.
I am a 68 year old psychiatric survivor who barely survived his encounter with shrinks, including a time in a Conn. state hospital and a lot of forced drugging.
I was able to find people to talk with and with time, was able to sort things out and get out from under the unbearable weight of trauma and stigma. You haven’t lived until you are carted off to a state “hospital” under the mythical diagnosis of schizophrenia, tied down to beds and forcibly injected with prolixin and thorazine until you are nearly unconscious.
I did make a video and encourage survivors like me to do the same, as a way to gain clarity and fight back. https://www.youtube.com/watch?v=iScTrOUIQxc
People talk about wars far away, but for most traumatized people the war is right here, and it involves allies like you, and greed-head enemy like big pharma embracing psychiatry.
Hugh Massengill, Eugene
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Excellent article. Good to see that traditional psychiatry (the “talking cure”) is not entirely dead.
However, I would echo prior concerns about the educational requirements for future psychiatrists. Why go to medical school if you are reluctant to medicate?
I’ve worked in and out of inpatient settings for 17 years now. I’ve had very little success with using therapeutic interventions other than basic supportive counseling with the severely mentally ill (schizophrenia, bipolar d/o). Meds seem to be the quickest way to reduce sx and get them feeling better about themselves.
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Why go to medical school indeed! One indicator that sites like MIA are making a difference would be to track the number of psychiatrists graduating from our medical schools. I’ve heard from several that the field has been reduced to that of a “prescriber” and you don’t need to go to medical school for 5-7 min med checks every 3 months.
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“Traditional psychiatry” is still based on the idea that emotional distress is a medical matter, and accepts absurdist concepts of “mental health” and “mental illness.” Acceptance of such inevitably leads to the semantic non-sequitur of using “medicines” for mental “diseases.” A slippery slope.
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“Meds seem to be the quickest way to reduce sx and get them feeling better about themselves.”
Oh I’m sure they do. Instead of anti-psychotics, why not try paralyzing drugs? They also make people calmer.
I suggest you try some of these drugs yourself and see how awesome you feel.
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I wonder why the guy who contacted you did not simply seek out a therapist rather than an MD/psychiatrist.
Regarding therapists profiteering from therapy, as Duane said, that is another problem. I hope there can be more programs like this – http://www.ctvip.org/
where people do volunteer work in exchange for free or very low cost therapy. In this way the poorest people, who are more frequently distressed and more severely distressed than middle-class or rich people, can access help that actually has a chance of being transformative, unlike zombifying pills.
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I’m not saying that making a profit is bad; rather that it’s interesting that those who are opposed to profits are silent when it comes to psychotherapy.
Nor am I heartless. What about more private non-profits? Keeping records private, keeping labels off; using sliding scales; pro-bono for those who simply cannot afford counseling/therapy?
I’m not so sure parity is a great idea; nor that taxpayers need to bear more burden.
Duane
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In Dallas, the Salesmanship Club offers this. It is entirely funded by proceeds from the Byron Nelson Golf tournament… A bunch of those rich guys… Go figure. And I know that many people would help fund similar programs around the country, if insurance “parity” and tax money didn’t create the false image that this was already being addressed. It would of course the shopping of bashing “the rich.” A favorite passtime on MIA.
Duane
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Typo – … require the stopping of bashing…
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I can’t imagine why anyone looking for a good therapist would seek out a psychiatrist. There are good psychotherapists everywhere. Many advances in psychotherapy have occurred in the last twenty years. The good therapists are clinical psychologists, clinical social workers and marriage and family therapists. A few good therapists are licensed as psychiatrists, but not many.
Everyone but Robert Berezin seems to understand this. Psychiatric medication also has a place, and some people desperately need it. And, of course, some people need psychiatric medication AND psychotherapy. Psychiatric medication is sometimes helpful, sometimes not. Same goes for psychotherapy. The current system has been well-established for about twenty-five years.
Psychiatrists try to make about $400 per hour for writing prescriptions. Therapists try make $50 to $150 per hour for doing therapy. (Most therapists get $50 to $75 per hour from health insurance.) Everybody seems to understand this except Robert Berezin.
This might not be the ideal system, but it’s not the catastrophe that Berezin makes it out to be. If he wants to practice psychotherapy, he’s free to do it. No one will stop him. Maybe he’s a good therapist… He probably won’t make $400 per hour, though.
I wonder if Berezin believes that only psychiatrists are smart enough to be really good therapists. If so, this would represent inexcusable arrogance. Berezin was apparently trained to be a psychoanalyst. Psychoanalysis is still available in every major city. It’s too expensive, and controlled trials have demonstrated that it is not an effective treatment. For these reasons, psychoanalysis is much less popular than it used to be, and health insurance won’t pay for it, nor should they. Health insurance won’t pay for other ineffective, overly expensive and obsolete forms of treatment.
Fifty years ago, most psychoanalysts were psychiatrists. That has changed. Today, psychoanalysts are more likely to be clinical psychologists, and possibly some other licenses, or lay analysts. This depends on the training institute.
I really don’t understand Robert Berlin’s main concern. C’mon, Dude. State your case in a reply!
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“There are good psychotherapists everywhere.”
LOL… No there aren’t. There are almost no good psychotherapists.
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This comment is too all or nothing. Psychotherapists are not effective or noneffective, they are people with strengths and weaknesses and there’s a continuum of effectiveness.
Further, many metaanalyses show that psychotherapy more often than not significantly benefits people.
Here’s one example that cites a lot of others –
http://www.centerforselfdevelopment.com/pdf/000004-effectiveness-of-long-term-psychodynamic-therapy.pdf
And another one – http://www.researchgate.net/profile/Mauri_Marttunen/publication/5842489_Randomized_trial_on_the_effectiveness_of_long-and_short-term_psychodynamic_psychotherapy_and_solution-focused_therapy_on_psychiatric_symptoms_during_a_3-year_follow-up/links/0deec5243de039c247000000.pdf
If you look at this second study, it’s pretty impressive how much long-term therapy relationships usually help people over time.
Of course not every psychotherapy or therapist is “good” but that doesn’t mean that overall psychotherapy is not helpful.
If you still disagree with this, maybe you can respond with some evidence beyond an opinion showing that most psychotherapists are ineffective.
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Well, the first problem I have is the one with assessing psychotherapy using clinical trials and such. It can be roughly summarised here:
http://explainxkcd.com/wiki/index.php/1462:_Blind_Trials
The literature about psychotherapies is a mess and I my mind mostly because it can’t be anything else.
The second problem I have is the fact that these therapies essentially reproduce the same problem which exists in the medical model – they’re trying to fix the individual as if that person was somehow broken. It is entirely meaningless because people don’t live in a vacuum and their problems don’t come solely from within. Some people contribute their getting better over years to psychotherapy but it can be as easily contributed to their changed circumstances or simply growing out of a bad emotional phase.
Why I say that there are almost no “good” psychotherapists – well, that’s just personal experience.
I’m not against psychotherapy as much as I am against psychiatry. If you think it helps you, you’re free to engage in it. But the same standard as to drugs should apply and that is informed consent.
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Informed consent, absolutely, I agree with you.
As for therapies having the same problem as the medical model (i.e. assuming the person is broken)…. I wonder what therapies you have in mind.
There are many different schools of therapy and a good number of them focus on people’s strengths, resilience, and ability to change their circumstances. Psychodynamic psychotherapy and ACT would be two examples. But of course the therapist’s personality and how they view the person they try to help is much more important than whatever orientation they have. And many, many therapists don’t subscribe at all to the broken-person model you described. I don’t know this, but I would suggest this is a projection you’re having onto most therapists.
As for psychotherapy being able to be measured in a randomized or blinded fashion… psychotherapy research does have its problems. But human relationships and their effects over time also do not lend themselves to the type of quantitative research we are looking at.
As for your last point, I totally agree. I am virulently against the medical model of emotional distress and anti long-term use of medication in almost all circumstances, as you can tell from reading my comments. So we are together on that.
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“There are good psychotherapists everywhere.” LOL… No there aren’t. There are almost no good psychotherapists.
I agree — that has been our family’s experience.
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I understand your point, but there can be reasons why someone would seek out a psychiatrist who is also a good therapist. I do think thatDr. Berezin knows that there are many good therapists who aren’t psychiatrists. I think that he is concerned that many psychiatrists these days have no clue about being a good therapist, which leads to many problem. Any psychiatrist that hasn’t been trained and doesn’t do therapy can have no idea of what can actually help a person to feel better and what is the natural evolution of any condition with good therapy. This makes the assessments of these psychiatrsits next to useless.
As you pointed out medication can be useful to some people. One of the benefits of a psychiatrist therapist is the ability to prescribe medication as an aid to the therapeutic process while seeing first hand how the two modalities can work together.
Another benefit, where I live, is that people can see me in therapy with no cost to them, and with no limits on the number of sessions that they can have. It is true that I can get paid significantly more for medication work, but I choose to devote most of my time to doing psychotherapy. I do think that it would be good if psychologists could be covered under Medicare here the way psychiatrists are. For now, I tend to refer people who can afford it to psychologists, and treat in psychotherapy people who can’t afford private therapy.
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“All psychiatric symptoms are the expression of our problematic characters.”
Well… no. I’ve agreed with the article up until this point. It’s again this same rhetoric that places blame and looks for solutions solely within an individual. It may not be as destructive as the biological model but it’s still harmful.
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Totally agree – this statement assumes that psychiatrists don’t have such characterological flaws, and that all “defect” sits firmly with the patient. The only supporting evidence for that is that the patient is the one who has acknowledged they are uncomfortable.
The psychiatrist treating them could be way “sicker” but not have the desire or courage to admit it. Or they might realise that it would be a career-ending move and that it is far more profitable to label others .
…but, of course, you would have to be bloody mad to see a psychiatrist!
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Psychiatric symptoms are NOT symptoms of problematic characters. Most the time, people go to the mental illness industry and thus psychiatrists because of their pain. This pain usually results from sort of trauma or abuse; some of it downright horrific or represensible. However, most of it usually results from the fact that many people have been “mistreated” by parents, schools, society, etc. that does not recognize their unique gifts and the way they might contribute to society. We are all not alive. Each of us is a unique blend of many characteristics, intelligences, temperaments, personalities, abilities, skills, talents, gifts. Some of us may be threatening to parents or schools in our uniqueness. Many times, the person seeks help to understand himself and is rebuffed to the “mental illness industry” including the associated governmental puppets, vocational rehabilitation. I have yet to figure out what they rehabilitate as how can you rehabilitate someone from their true God-given self.
There are a lot of excellent books available that explain the fact that we are unique individuals and that is alright to be just who you. Sadly, many times in these times; being just who you are leads to a prescription of toxic, addictive psychiatric medication that just might kill you. The other related problem is the innate selfishness of some parents to their children which can also lead to dismay and feelings that are toxically treated with medication and useless therapy that continues to find fault with the individual and disregards the pain they have endangered from the parents or school. There is no easy solution.
Yet, I fell DRUGS AND THERAPY ARE NOT THE ANSWER!! The answer lies in learning who you are, your gifts, your intelligences, your right or left brain preference, your natural temperament and personality type and anything else that can help you in realizing you are a worthwhile person and you have a God-given purpose on earth. When, I cam along we did not know as much about these things as we do now. However, when I was growing us, kids were not drugged as they are now. Yet, we know more about how we are unique individuals than we do now; and we somehow forget it and prefer the toxic, addictive drug and therapy excuse for all age groups; adult and child. I say this: It is never too late to find out who you really are; your strengths, intelligences, the way you learn, whether you prefer the right brain or left brain, etc. All I suggest is please stay away from the “new age whoo-whoo” and your local psychiatrist, mental health clinic and vocational rehabilitation. Vocational Rehabilitation will test you, say so and so about you, and then do absolutely nothing to help you realize any accomplishments (possible ways of employment) from who you are, and then wonder why you are dismayed. Thank you.
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