Ronald Pies, MD, is one of American’s most eminent and prestigious psychiatrists. He is the Editor-in-Chief Emeritus of Psychiatric Times, and he is a Professor of Psychiatry at both Syracuse and Tufts.
I disagree with many of Dr. Pies’ contentions, and I have expressed these disagreements in detail in various posts (for instance, here, here, and here). But there is one area where I have to acknowledge Dr. Pies’ efforts: he never gives up in his defense of his beloved psychiatry, even in the face of the most damaging counter-evidence.
For instance, on more than one occasion, he has asserted, with apparent sincerity and conviction, that psychiatry never promoted the chemical imbalance theory of depression!
Here’s a quote from Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, April 15, 2014:
“…the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.”
And from Serotonin: How Psychiatry Got Over its “High School Crush”, on September 15, 2015:
“Alas, antipsychiatry bloggers continue to bang away at the notion that ‘Psychiatry’ (that sinister, monolithic corporate entity) deliberately duped the public by promoting a bogus ‘chemical imbalance theory,’ in cahoots with ‘Big Pharma.’ Suffice it to say that this line of argumentation is itself bogus, for reasons I have reiterated at length in several venues.”
His latest contentions in this area were demolished by Robert Whitaker on September 21, 2015, but Dr. Pies has demonstrated a remarkable resilience against factual material that runs contrary to his cherished notions. So it remains to be seen whether or not he will be back with this particular message.
. . . . .
Meanwhile, he’s working on another buttress to shore up the crumbling psychiatric sandcastle. On October 7, 2015, he published Psychiatry’s Solid Center in the Psychiatric times. Here’s the opening paragraph:
“Most psychiatrists do not fit neatly into the biological or psychodynamic camps. Instead, like surgeons, they will implement tools that reduce the suffering and enhance the well-being of the patient.”
I’m not familiar with the state of psychiatry at Syracuse or Tufts, but in the rest of the US, the vast majority of psychiatrists very emphatically do fit neatly into the biological camp, and do conduct their practices in accordance with a simplistic biological model.
Of course, my experiences are limited by my horizons. It may be that, outside of my ken, psychiatrists are busy providing hour-long therapy sessions to their clients – helping them identify and unravel their unconscious emotional conflicts, or engaging in family therapy, conflict resolution, skill training, etc. Or maybe not.
Douglas Mossman, MD, Professor of Psychiatry, and Director of the Institute of Law and Psychiatry at the University of Cincinnati, has written on this topic. Dr. Mossman writes a regular column called Malpractice Rx in the publication Current Psychiatry. The following quote is from an article dated June 2010, and is in response to a reader psychiatrist who had asked how he could “…attend to patients’ needs, be empathic, listen actively, and still produce proper documentation?”
“In medical malpractice cases, the jury decides ‘whether the physician’s actions were consistent with what other physicians customarily do under similar circumstances.’ Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”
In other words, if all, or even most, psychiatrists are doing 15-minute med checks, then there is little chance of a successful malpractice suit. He is also saying quite clearly that 15-minute med checks have become “standard care” in psychiatry. And lest there be any residual uncertainty, at the end of the article under the heading BOTTOM LINE, Dr. Mossman wrote:
“Brief medication visits—also known as 15-minute ‘med checks’—have become standard care in psychiatry.”
Not much ambiguity there.
. . . . .
And Glen Gabbard, MD, a widely published professor of psychiatry at Baylor and, interestingly, Syracuse, has written in Psychiatric Times, on September 3, 2009:
“There can be little doubt in our current era that the brief ‘med check’ is becoming standard practice in psychiatry.”
This was in 2009, and there have been no indications in the interim that psychiatry is backing away from this approach.
So if the majority of psychiatrists are spending the majority of their practice time doing 15-minute med checks, isn’t it reasonable to infer that they might “fit neatly”, to use Dr. Pies’ own phrase, into the biological camp? And in fact, Dr. Pies himself, in an earlier paper (Psychiatrists, Physicians, and the Prescriptive Bond) has written:
“Unfortunately, many prescriptions for psychotropics are written in haste—often after the infamous ’15-minute med check’ – and without any real understanding of the patient’s inner life or psychopathology.”
. . . . .
Dr. Pies continues by telling us that he was fortunate in that his psychiatric training was fostered by those in what he calls the “great solid center” of psychiatry. This is interesting, of course, and one can readily entertain feelings of joy and gratitude, that Dr. Pies apparently escaped the bio-reductionist nonsense, that has now become a dominant feature of psychiatric training and practice.
Dr. Pies continues:
“And critics of psychiatry who insist that the field has become exclusively ‘biological’ are also missing the larger and more enduring picture.”
Well I think I could count myself as a critic of psychiatry, and I have to say that one of us is certainly missing the bigger picture. Since the 70’s, I have interacted with a great many psychiatrists in a wide range of contexts and locations, but I cannot recall one who conceptualized his/her role as anything other than the prescribing of drugs or high-voltage electric shocks to the brain. And in fact, I can recall only one psychiatrist, an elderly man who had trained in Vienna in the ’30’s, who expressed even the slightest regrets or misgivings in this regard. I can still remember his exact words: “I was trained as a psychotherapist, but all they want me to do now is prescribe drugs.”
Every other psychiatrist I’ve ever met has expressed nothing but satisfaction with what is sometimes referred to as the “drug revolution” that, according to the rhetoric, has enabled psychiatry to take its “rightful place” as a legitimate science-based medical specialty.
. . . . .
Dr. Pies continues at some length on the wide-ranging aspects of his psychiatric training. He tells us that at one point in his training, he ran a poetry therapy group on an inpatient unit, and that he “…became a believer in pragmatic pluralism and psychiatry’s crucial role as a bridge between the medical sciences and the humanities.”
This last statement is ambiguous, in that it could mean that Dr. Pies believes that psychiatry should be such a bridge, or that psychiatry is such a bridge. If Dr. Pies intended the former, then that’s interesting, though not pertinent to his main thesis, but if he meant the latter, then I suggest his contention is not only false, but entirely lacking in credibility. Indeed, in my experience, it is one of psychiatry’s great priorities to dispel any such perceptions, and to establish itself as a “real” medical specialty with expertise in biochemistry, drugs, electric shocks, etc… In this regard, it is noteworthy that Jeffrey Lieberman, MD, arguably the greatest and most eminent psychiatrist in the world today, has appeared in promotional videos wearing a white lab coat! One wouldn’t want to make too much of this. Perhaps he just couldn’t find anything else to wear. But it certainly militates against the notion that psychiatry is involved in any bridge-building to the humanities.
Dr. Pies tells us that in his 35 years of practice, psychiatry has been such a bridge for him, and I certainly have no reason to doubt this. But this is not, I suggest, an accurate description of psychiatry generally. Indeed, with a measure of wistfulness, Dr. Pies himself concedes this point:
“Maybe that’s why I find it so troubling that many in the general public—and indeed, many within the profession—see psychiatry as having pitched its tent squarely and solely in the ‘biological’ camp.” [Emphasis added]
Note the phrase: “…many within the profession…” I would say the vast, vast majority within the profession, but let’s not quibble over details.
. . . . .
Back to Dr. Pies’ article:
“This perception [that psychiatry has pitched its tent squarely and solely in the biological camp] is not without some foundation, and there is no question that, in the 1990s, American psychiatry took a ‘biological turn’ that has never fully swung back to the psychosocial end of the continuum. But to view today’s psychiatry as merely biology-based is to see it ‘through a glass, darkly.’ When we look to the solid center of this profession, we see thousands of skilled clinicians, researchers, and teachers who are as comfortable with motives as with molecules. The solid center rejects the notion that we must choose between biology or psychology, between medication and psychotherapy.”
Well, perhaps we, on this side of the debate, are seeing psychiatry “through a glass darkly”, but I suggest it is more plausible that Dr. Pies is seeing his beloved profession through a rose-colored glass. He tells us that there are “thousands of skilled clinicians, researchers, and teachers who are as comfortable with motives as with molecules”. This may be true. But in their actual work, the vast majority of clinicians and researchers appear far more concerned with the latter. Indeed, indifference to motivation has been enshrined in the DSM since Robert Spitzer’s DSM-III. Within the context of “psychiatric diagnosis”, it doesn’t matter why a person might, for instance, be very suspicious of his neighbors. If the suspiciousness crosses a vaguely-defined threshold of severity/implausibility, then it becomes a symptom of “schizophrenia”. Similarly, if a child is routinely disobedient to his/her parents, no attempt is made within psychiatry to explore why this might be so. The disobedience is simply chalked up as a “symptom” of oppositional defiant disorder. Similarly, no attention is given within the DSM as to why an individual is feeling depressed, anxious, angry, etc.. The presence of the particular thought, feeling, or behavior is all that’s needed to establish the “diagnosis”, and the “diagnosis” is all that’s needed to justify the prescription. The why questions are never even asked.
Daniel Carlat, MD, Associate Clinical Professor of Psychiatry at Tufts, and author of the book Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, is very open about this. Here’s a quote from an interview he gave on NPR on July 13, 2010:
“…there’s kind of an unofficial policy among psychiatrists, at least among some, which is the don’t-ask-don’t-tell policy, which is that we have our patients coming in, we know we have 15 or 20 minutes to see them. We want to learn a certain amount about how they’re doing, obviously, because we want to make sure that our medications are working and that we know if we need to increase the dose or add something else.
But on the other hand, we don’t want to ask too many questions because if we start to hear too much information, then we’re going to run into a time issue where we’re going to have to kind of push them out of the office perhaps just at the point where they’re about to reveal something that could really be crucial to understanding their treatment.”
Sounds a bit like biological psychiatry to me.
. . . . .
Back to Dr. Pies:
“As a broad generalization, those in the center conceive psychiatric ‘disease’ as something that afflicts persons, not ‘minds’ or ‘brains’—a point stressed by the late Dr Robert Kendell. Thus, the ‘mental versus physical’ debates are seen as sterile and fruitless. Those following the ‘Middle Path’ (to borrow a term from Buddhism) are preoccupied not with elaborate theories, but with relieving the suffering and incapacity of those who seek our help. Those in psychiatry’s solid center use the best established treatments to alleviate the patient’s illness—whether with ‘talk therapy,’ medication, or both.”
There are several noteworthy features in this paragraph. Firstly, note that Dr. Pies has placed the word “disease” inside quotation marks. In normal usage, this would indicate that he’s using the word to mean: not a real disease. A Freudian slip perhaps, as Dr. Pies has asserted the disease status of psychiatric “diagnoses” on many previous occasions.
Secondly, the first sentence in the above quote is a truly delightful piece of psychiatric spin. Let’s open it up. Dr. Pies is asserting that he and his right-minded colleagues in the “solid center” conceive of psychiatric disease as something that afflicts persons, not minds or brains. But this is entirely incidental to the main issue. Take, for example, depression. Psychiatry conceives of this as an illness (provided a certain ill-defined level of severity is present) – specifically an illness of the brain. Those of us on this side of the debate argue otherwise – that it is not an illness, but rather the normal, adaptive response to loss, or to an unfulfilling lifestyle. But both groups agree, indeed it’s hard to imagine how we could disagree, that depression afflicts persons. Even the most die-hard bio-reductionist would subscribe to that: depression is a brain disease that afflicts the person who owns the brain! While those of us on this side would say: depression is a normal reaction to depressing events/circumstances that afflicts the person experiencing these events/circumstances.
What Dr. Pies has done here is make a statement that looks and sounds like an important distinction, but which in reality is banal to the point of meaninglessness. And he’s used this non-distinction in his ongoing, futile attempt to defend his beloved profession. But he’s avoiding the reality: that psychiatry’s blatant promotion of its various illness theories is a hoax.
Thirdly, the statement “Thus, the ‘mental versus physical’ debates are seen as sterile and fruitless” has similar problems. The issue is not “mental vs. physical”, posed by Dr. Pies as a kind of theoretical dichotomy. The issue is whether or not depression, say, should be conceptualized as a normal response to depressing events/circumstances or as a neurological pathology. This is not a sterile or fruitless debate, and by mischaracterizing it as such, Dr. Pies is either being deliberately deceptive, or has missed the point of the entire conflict. In fact, whether depression should be conceptualized as a normal response or as a neurological pathology isn’t really a matter for debate at all. It’s a question of fact: do all the individuals whom psychiatry identifies as having depressive illness have a characteristic neural pathology? After forty years of highly motivated and well-funded research, no such pathology has been identified, and the time honored notion, that depression is the normal response to depressing circumstances is as credible today as it has always been.
Fourthly, “Those following the ‘Middle Path’ (to borrow a term from Buddhism) are preoccupied not with elaborate theories, but with relieving the suffering and incapacity of those who seek our help.” In other words, Dr. Pies and his stalwart colleagues from the solid center are not preoccupied with elaborate theories, (which is good to know, because as a general rule, most of his incursions in this area are riddled with error and fallacy), but with relieving the suffering and incapacity of those who seek their help. And here again, dear readers, marvel at the spin – the implication, so beautifully and expertly wrapped up, that those of us who do feel strongly about psychiatric fallacy, deception, and destructiveness, are somehow neglecting our responsibilities to relieve the suffering and incapacity of those who seek our help. Such cads we are. But never worry, Dr. Pies and his cadre in the “solid center” will step into the breach of our remissness, pick up the slack, and minister dutifully to those who seek their help. This is such a comfort!
As I’ve said on other occasions about Dr. Pies’ writings: this is doctoral level spin.
. . . . .
Dr. Pies next provides brief sketches of Karl Jaspers, MD, Eric Kandel, MD, and Glen Gabbard, MD, all of whom Dr. Pies describes as exemplary of the “holistic tradition”. These are interesting diversions, of course, but they shed no light on Dr. Pies’ primary thesis that “Most psychiatrists do not fit neatly into the biological or psychodynamic camp.”
The great irony of all this is that to the best of my knowledge, Dr. Pies has never aligned himself with the bio-reductionist majority, that has dominated psychiatry for the past 40 or 50 years. But no amount of humanism or eclecticism can rescue him from psychiatry’s fundamental and pervasive fallacy: that all significant problems of thinking , feeling, and/or behaving regardless of their genesis – are illnesses. The fact is that the vast majority of problems of thinking, feeling, and/or behaving are not illnesses, and that treating these problems as if they were illnesses is counter-productive, disempowering, stigmatizing, and deceptive. This is the critical issue that no amount of psychiatric sophistry or verbal chicanery can neutralize.
Dr. Pies indicated in the article that he has a liking for poetry. I also have a fondness for poetry, and in the current debate, I often find comfort in the poem Say not the Struggle nought Availeth, by the great Victorian poet Arthur Hugh Clough. Here’s the third stanza:
“For while the tired waves, vainly breaking, Seem here no painful inch to gain, Far back, through creeks and inlets making, Comes silent, flooding in, the main.”
The main, Dr. Pies, a symbol of that great, cleansing surge of truth and logic, whose flowing tide is already eating at psychiatry’s foundations, and which will one day, when the lifeline of pharma money dries up, wash psychiatry, and all its spurious trappings, into the depths of historical obscurity.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Dr. Paes is like a genial real estate salesman who shows you through a house emphasizing only the positive, surface, normal-appearing aspects, while not taking you to the basement where the entire foundation has rotted away (or was never solidly built in the first place). The rotten foundations in psychiatry are spurious diagnoses, massive overdrugging, and overfocuses on reductionistic biological explanations of human problems.
I’ll comment on several parts of Hickey’s essay:
“Most psychiatrists do not fit neatly into the biological or psychodynamic camps. Instead, like surgeons, they will implement tools that reduce the suffering and enhance the well-being of the patient.”
This is an interesting quote if you step back from it. It implies that the patient is some inert vessel that the psychiatrist is “operating on” like a surgeon. There is not a sense of collaboration between psychiatrist and patient, of subjectivity or desire or freedom of choice for the client. Rather, the client has some problem or illness and the psychiatrist operates on him. And the client is identified as a “patient”, a medical word. Of course, Paes would argue that he does think in non-medical ways. But language does unconsciously reveal a lot about a person. It’s interesting that Paes denies that he or most psychiatrists fit into the biological camp, but then he uses a metaphor of treatment for “most psychiatrists” that on a deeper level is a biological one.
Phil, the following quote was funny,
“It may be that, outside of my ken, psychiatrists are busy providing hour-long therapy sessions to their clients – helping them identify and unravel their unconscious emotional conflicts, or engaging in family therapy, conflict resolution, skill training, etc. Or maybe not. “
When I got near the end of the first long sentence I was like, “Nooooooooo…” And then you said “Or maybe not.” And that made me laugh.
I remember a psychiatrist I saw who had never met me before, who took me inside his consulting office, and without asking me anything about myself, said “Here’s a piece of paper, list your symptoms, how long you’ve had them, and how bad they are.” Then once I’d done that a few minutes later, the rest of the session was spent talking about which medications might treat which symptom. It was incredible. I didn’t believe psychiatrists like this existed until I met this guy. It felt like meeting an alien, like Will Smith may have felt when he entered the alien spacecraft in the movie Independence Day.
Regarding this, “”And critics of psychiatry who insist that the field has become exclusively ‘biological’ are also missing the larger and more enduring picture.”
This is so disingenuous of Paes. Surely he cannot be unaware of how the overwhelming majority of research in psychiatry is narrowly focused upon biological, genetic, reductionistic diagnosis-related explanations of human sufferings. That is the larger and more enduring picture in American psychiatry.
Phil – You think you could count yourself as a critic of psychiatry? Are you sure? 🙂
I think I’d be diagnosed as a critic of psychiatry too.
As for this, “When we look to the solid center of this profession, we see thousands of skilled clinicians, researchers, and teachers who are as comfortable with motives as with molecules. “
Again this is totally disingenuous on the part of Paes. “As comfortable with motives as with molecules” – this suggests that most psychiatrists see clients as people with individual desires, dreams, and preferences as much as they see them as inert vessels whose brains are affected by mental illnesses. And that’s just bullshit. It may in fact be that Paes himself tries nobly to operate this way with most of his clients, but cannot perceive that most of his colleagues do not.
This was a good poetry snippet,
“”For while the tired waves, vainly breaking, Seem here no painful inch to gain, Far back, through creeks and inlets making, Comes silent, flooding in, the main.”
I also feel that psychiatry may be more vulnerable to breakdown than is commonly thought. The lack of validity of psych diagnoses and the ineffectivness and harms of drugging leave it so vulnerable to attacks from which there is no long-term escape… because biological and genetic research is not going to uncover valid mental illnesses that are treatable with drugs. Maybe psychiatric practice as it currently done – i.e. including the myths that psychiatric diagnoses are valid and necessary and that drugs should be an integral front-line approach – is already doomed by processes already in motion, like increasing awareness spread by the internet and sites like MIA. Biological psychiatry practice may be like the Titantic some time after it left Southampton.
There is one more major long-term threat to psychiatry that not many have considered. Psychiatry – involving mass production of medication and training of doctors at institutions – is a recent product of the industrial age, i.e. of massive use of fossil fuels in the last 150 years. A blink of the eye in the history of humanity, and a smaller blink in the history of Earth and time. When fossil fuels dwindle over the next 100-200 years, and they will, then industrial civilization’s survival will depend upon renewable energy and/or nuclear energy. Should one or both of these not scale up sufficiently, and the global economy have to become much more localized and much less energy intensive, that could be a fatal blow to psychiatry. Drugs would no longer be able to be produced at scale, and training of and communication between psychiatrists would slowly collapse.
People think this scenario is impossible, but as Jared Diamond wrote about in his book Collapse, every great past civilization has eventually fallen, and there is no reason that countries like the United States and other industrial nations could not collapse given severe resource shocks and poor choices about how to manage energy, food, etc. Such a collapse would take psychiatry and many other non-essential modern industries (among which psychiatry certainly is) down with it.
Some interesting blogs taking this long viewpoint are –
Charles’ Hugh Smith’s Of Two Mind (warning – do not read this if you are easily scared) –
And Out Finite World –
Psychiatry will not survive in anything close to its current form if humanity doesn’t adapt well to challenges like climate change, fossil fuel depletion, and depletion of other resources.
You’ve hit a huge nail on the head in your comment on Dr. Pies’ surgeon analogy. In theory, there’s no reason why an MD couldn’t become a good therapist – but he/she would almost have to forget or set aside the medical training. In this are, it’s more a liability than an asset.
Thanks for the links.
“I’m not familiar with the state of psychiatry at Syracuse or Tufts….”
Actually, do have some idea of the state of psychiatry at Tufts, and the bar they set could not be any lower. Please recall that Rebecca Riley, the Massachusetts toddler who was labeled bipolar and drugged with psychoactive neurotoxins was treated by a Tufts University Medical Center psychiatrist. The following excerpt is from Dr. Bruce Levine’s April 17, 2014 post on MIA:
When Rebecca Riley was 28 months old, based primarily on the complaints of her mother that she was “hyper” and had difficulty sleeping, psychiatrist Kayoko Kifuji diagnosed Rebecca with ADHD. Kifuji prescribed clonidine, a drug with significant sedating properties, a drug that Kifuji also prescribed to Rebecca’s older sister and brother. The goal of the Riley parents—obvious to many people in their community and later to juries—was to attain psychiatric diagnoses for their children that would qualify them for disability payments and to sedate their children making them easy to manage. But apparently this was not obvious to Kifuji who, when Rebecca was three years old, added a bipolar disorder diagnosis and prescribed two additional heavily sedating drugs, the antipsychotic Seroquel and the anticonvulsant Depakote. At the age of four, Rebecca died due to the toxicity of these drugs. After Rebecca’s death, Tufts-New England Medical Center, Kifuji’s employer, told ’60 Minutes,’ ‘The care we provided was appropriate and within responsible professional standards.’ ”
So, there you have it. According to Tufts, what happened to this little girl was appropriate and responsible professional treatment. This underscores the very point that I believe you are making: when everyone, the whole rotten system, is guilty, no one is guilty.
“When everyone, the whole rotten system, is guilty, no one is guilty.” And this is the root of the problem, I absolutely agree, GetItRight. “Power corrupts, and absolute power corrupts absolutely,” and the entire psychiatric system has intentionally, or unintentionally, chosen to become absolutely corrupted.
For example, Whitaker and others, pointed out that the etiology of the American childhood “bipolar” epidemic was due to misdiagnosing the adverse effects of antidepressants and ADHD drugs in children, as “bipolar.” A common misdiagnosis technique, which was propagandized into existence, by Harvard’s Joseph Biederman, due to his greed inspired promises to increase sales of Risperdal, in the pediatric market.
And I say this is misdiagnosis, because it was specifically stated in the DSM-IV-TR, which was psychiatry’s “bible” at the time, “Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”
And how does the psychiatric industry choose to deal with what resulted in an almost unfathomable in scope misdiagnosis / blatant malpractice problem? They choose to cover it up, by making such misdiagnoses “appropriate care” in their DSM5.
And this, despite the fact, all doctors should know that adding antipsychotics / neuroleptics (like Risperdal) to antidepressants will in all likelihood result in a known polypharmacy induced toxidrome, called anticholinergic intoxication syndrome. And this syndrome results in an illness that emulates the positive symptoms of “schizophrenia.” From drugs.com:
“Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”
This is a story of how to iatrogenically create the positive symptoms of “schizophrenia” in millions of American children, and adults, too. “When everyone, the whole rotten system, is guilty, no one is guilty.” This is a huge societal problem.
By the way, thank you for another wonderful critique of the spurious nature of the psychiatric industry today, Philip.
You’re welcome. And thanks for drawing attention to the drug-induced “bipolar epidemic”.
Get It Right,
Thanks for drawing attention to this truly appalling tragedy.
Thank you for such a beautiful and elegant article.
You’re welcome. And thank you for your encouragement.
Looks like I’m getting into this debate on the ground floor so allow me to proffer this for now:
If there were any legitimacy to psychiatry it could only be so if there were demonstrably pathological, organically-based brain diseases which caused people to exhibit socially and/or politically disturbing thought and behavior. Otherwise they’re stuck with “mental” illness, which they probably understand instinctively at some level is a crock.
As for affecting the “person” rather than the brain or the mind, no cigar and not even close. The person is material, like the brain. What part of the person? The mind, on the other hand, remains an intangible abstraction and not susceptible to disease.
And “the Middle Path”? Give me a break! Rather than blend psychiatry with Buddhism I’ll take pure Buddhism any day, if those are my only options…
Thanks for coming in. Yes – the brain pathology notion is psychiatry’s only hope for legitimacy, which is why they are so reluctant to let it go. But I think you’re right – in their “hearts”, they know it’s nonsense.
As you say, the Ronald Pies piece was all spin. Psychiatry has been unable to find any reliable bio-markers. Such a failure does in any thoroughly biological approach. Psychiatry still has to justify all those years undergone in medical school, therefore, it can’t dispense with the biological. Truly scientific research means less than spin. You have a “central tent’ so-called because one end of the spectrum has been disproved and the other end doesn’t support the guild’s business interests. How convenient. We’re still not talking about anybody suspending his or her bias in the interest of science. Bias rules the field. Perhaps we should wait until the evidence is in before deciding on approach A, approach B, or approach C. Well, if so, that’s going to be a long wait. Suspension of bias is not on the agenda as far as the profession itself is concerned. Suspension of bias doesn’t support the profession’s guild interests. Spin, propaganda, and public relation campaigns, such are the stuff the APA’s war on truth is made of. Impartial is not a word you would use to describe this kind of ‘war against our critics’ business.
Yes, that’s all they’ve got: spin, propaganda, and PR.
Great article; thank you for your defense of the disenfranchised.
Prior to the DSM III, when psychiatry predominately provided social welfare counseling through psychotherapy, other medical sciences chastised psychiatry for failing to be a real medical science. The criticism was pointed; all other medical sciences pay primary homage to biology and biological reductionism. The move to redefine mental distress as a biological problem in the DSM III was a leap in scientific respectability for psychiatry. Although the scientific respectability is waning with increasing criticism of its pseudoscience; the chemical imbalance theory is a logical effort by psychiatrists to explain mental distress with biology. When the pseudoscience of the chemical imbalance theory reaches critical mass, psychiatrists will migrate to another theory of biological causation that is more complex and more difficult to challenge.
Isn’t the term “biological psychiatry” redundant; isn’t psychiatry a medical science and isn’t medical science based on biology?
Best wishes, Steve
Yes, they embraced biology because they had become ashamed of what they were. And they staked everything on the chemical imbalance theory – which is already yielding – as you predict – to neural circuitry anomalies – and who know what else?
I’m thinking Dr. Pies’s rhetoric fits nicely with the “positive psychiatry” movement of Dilip Jeste, a former APA President and editor of “Positive Psychiatry: A Clinical Handbook.”
Yes. Lots of parallels there. Thanks for pointing this out.
“Instead, like surgeons, they will implement tools that reduce the suffering and enhance the well-being of the patient.”
“We are real DOCTORS goddammit! We do MEDICINE.”
Yes! Who’s he trying to convince?
Was this misquoted?
“Unlike surgeons, we are ‘tools’ that will enhance the suffering of patients”
Yep. From “antidepressants” that cause depression to “antipsychotics” that cause tardive psychosis.
Which also means we must maintain the mystical aura of the infallible and selfless mercies we bestow upon our patients and not be seen to have erred in any capacity that we could be libel for regardless the actual damage caused as we circle the wagon’s for the greater good of the guilds with the sign of the snake emblems , pseudo science notwithstanding , we are to big to fail . And yet we must protect our own family members from each other . It’s as American as apple Pie’s.
You know Philip when your clear analysis bumps into others lived experience together the sparks that fly are part of the avalanche that will take the cynical medieval people eating monstrosity that psychiatry clearly is and finally bury it.
It worry’s me , like the tobacco companies before them that tied monkeys to chairs and force introduced into their bodies various substances as they searched for even more addictive chemical compounds to add to cigarettes hoping they could make it eventually impossible for people to quit using their adulterated product. It’s more than probable big pharma is doing the same type thing on a larger scale developing chemicals and biological substances both more addictive and damaging over the long term experimenting in the open air on people of all ages in the hope of delivering them disguised as medicines by making them more time released ,( what is the meaning of the intensifying of coercion in APA psychiatry, and in AMA vaccinations and psychotropic and other toxic prescribing , along with “radiation and chemo -therapy” just for starters, unlabeled GMO foods , fluoride in drinking water, and unregulated other deadly substances released into the environment ) , similar to the Nazi’s disguising extermination by gas as hygienic showers. We need there to be more inside whistle blowers anonymously revealing secrets of these cartels and various other corporate government “enterprises” to the people whose lives are greatly endangered by the combined effect of the eugenic direction of cartel activities. Population reduction has long been a well financed dream of Rockefeller and Carnegie and others. They also seek to make it a profitable enterprise .
The question is that as unthinkable as this all is, what can waken the people to do something together about these common problems that the powerful must feel their money makes them immune to . They must take comfort in that they also control the main stream media .I guess they don’t intend to change their ” way of life” and feel killing off the majority and enslaving some of the population for profit is their chosen method of environmental control of the planet. I hope things take a turn for the better .
I can see why Dr. Pies is a shrink and not a journalist. What a bunch of pretentious, purple prose! And it really conveys no more science than the “technobabble” actors ad lib in Star Trek episodes.