Last month (February 2016), the British Journal of Psychiatry published an online bulletin titled BASH: Badmouthing, Attitudes and Stigmatisation in Healthcare as Experienced by Medical Students, by Ali Ajaz et al. Here’s the abstract:
“Aims and method We used an online questionnaire to investigate medical students’ perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments (‘badmouthing’ or ‘bashing’) against other specialists and whether this has had an effect on their career choice.
Results In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine.
Clinical implications Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.”
Note in the “Clinical implications” the assertion that “bashing” psychiatry “has the wider effect of stigmatizing people with mental health disorders.” This contention, which is widely promoted by psychiatry, is, I suggest, simply false. Criticism of psychiatrists neither entails nor implies any criticism of their clients. Indeed, within the anti-psychiatry movement, where the criticism of psychiatry finds its most vocal and ardent expression, psychiatry’s clients are routinely afforded a very high level of consideration and respect. Indeed, it is my impression that more than half of the individuals associated with the anti-psychiatry movement are themselves former “patients.”
A second noteworthy matter is the use of the term “bash” in the title and in the Clinical implications section. The issue here is that it is apparently common practice in medical schools for students and faculty to make disparaging remarks about specialties other than their own. It is also clear, from the survey itself, that the practice is not seen as particularly harmful or serious.
“The majority of comments (40.4%), either directly or indirectly, minimised any negative connotations associated with badmouthing other specialties or the impact on students’ future career choices. The most frequent comments stated that badmouthing was nothing but harmless fun and was done without any maleficent intentions. There was a real sense among some students that badmouthing was beneficial as a source of conversation and bonding within clinical teams. There was some recognition that some medical students might be influenced by the negative comments about certain specialties, but this was dismissed as being due to their own insecurities about their career choice rather than being affected by the remarks.”
Using the word “bashing” to describe this kind of activity constitutes overstatement to a misleading degree. I have personally heard physicians make negative comments about psychiatry, but these have always been directed against the widely-acknowledged invalidity of its “diagnoses,” and the general lack of science in the development and assessment of its “treatments.” It is interesting in this regard that two of the three examples Ajaz et al provide of psychiatry-bashing were:
- ‘psychiatrists are not actual doctors’, and
- ‘psychiatry – not real medicine’
And, seen in this regard, it is clear that such comments are warranted. For decades, psychiatry has arbitrarily and self-servingly claimed as its legitimate domain all significant problems of thinking, feeling and/or behaving. Within this domain, they have invented and promoted a truly bewildering array of fictitious illnesses, for each of which they falsely claim to have highly effective treatments in the form of neurotoxic drugs and high-voltage electric shocks to the brain. Psychiatry has also conspired with pharma to produce a large body of fraudulent research and ghost-written books and papers to promote the sale of psychiatric drugs. And on the wider scale, psychiatry’s “diagnoses” are inherently disempowering and stigmatizing, and serve to foster a culture of drug-induced dependency.
Psychiatry remains utterly deaf to these kinds of criticisms. In fact, the more acutely and tellingly psychiatry is criticized, the more adamantly it defends its concepts and practices. But it seldom addresses the actual criticisms, relying instead on spin and on the endless regurgitation of the same tired old assertions: we’re real doctors; we treat real illnesses; our treatments are effective; and – as in the present context – we deserve more respect.
. . . . . . . . . . . . . . . .
All of this is very interesting, but there’s more. On February 27, the Royal College of Psychiatrists (the British equivalent of the APA) issued a press release on the Ajaz et al study. The release is titled Royal College calls for an end to ‘Bashing’ Psychiatrists.
Here are some quotes, interspersed with my thoughts and observations.
“The stigma surrounding psychiatry doesn’t begin and end with the experiences of patients; doctors too experience stigmatisation – for deciding to become psychiatrists.”
Note again, the spurious linking of the disparagement of psychiatrists with the stigmatization that attaches in some contexts to psychiatry’s clients. In reality, the primary source of the stigmatization of their clients is psychiatry’s long-standing, though false, insistence that these individuals have incurable brain illnesses for which they need to take pills for the rest of their lives (Angermeyer et al, 2011; Deacon, BJ, 2013; Read, J, et al, 2006).
. . . . .
“Medical students and trainee doctors are reporting that the badmouthing of certain medical disciplines is impacting on their freedom to choose psychiatry as a speciality, and the higher echelons of this specialist branch of medicine are fighting back.”
This is a truly extraordinary statement. Medical students and trainee doctors are reporting that negative comments about psychiatry that they hear around the colleges are impacting on their freedom to choose psychiatry as a specialty! Impacting on their freedom to choose! The poor lambs! Those mean ol’ real doctors just keep picking on them, and you know, they just don’t know what to do with their lives. Shouldn’t this be a “diagnosis” for DSM-6: Excessive-insecurity-about-vocational-choice disorder? But have no fear my little lambs, your leaders are fighting back!
. . . . .
“President of the Royal College of Psychiatrists, Professor Sir Simon Wessely is launching a campaign to support medical students and trainee doctors by exposing the practice of badmouthing – known as ‘bashing’ – that threatens to deplete an already under-subscribed medical specialism.”
So, in the best tradition of St. George the Dragonslayer, Sir Simon is going to “expose” psychiatry bashing. I wonder how that will work? Posting on bulletins the names of offenders? Public denouncements of psychiatry-bashers at the beginnings of lectures? Confessions from repentant bashers aired on campus media? And of course, an army of volunteer snitches. “Please, Sir, Dr. Wessely, in the cafeteria this morning I heard Rodney Thornwhistle saying that psychiatrists aren’t real doctors.”
And undoubtedly, psychiatric action will be swift and decisive. “Don’t worry, Willis, I’ll have the bounder stripped of his honors and drummed out of the college within the hour.”
“Oh, thank you Dr. Wessely. It’s been so upsetting; I hardly know what to do with myself.”
“Well take a few days off, Willis. We don’t want you contracting PTSD, do we?”
“Oh, thank you, Dr. Wessely. It’s such a comfort to have a person of your understanding at the helm.”
. . . . .
“Psychiatry continues to face a worldwide problem with recruitment. In the UK, the Royal College of Psychiatrists has maintained an active recruitment programme for several years, but rates of students interested in psychiatry as a career remain at 4-5%; insufficient to meet future needs.”
Arguably, the single most important factor in human endeavors is the ability to deal rationally and self-critically with our failings, personally and organizationally. Psychiatry is failing because it is everywhere being exposed as the facile and destructive hoax that it is. But psychiatry has always been averse to anything remotely akin to critical self-scrutiny. So they blame their decline on others. And here we see this process plumbing the very depths of inanity: recruitment is down because of the mean things that people are saying to psychiatry students in the medical schools!
. . . . .
“Professor Wessely said: ‘There is no psychiatrist in the land who cannot remember the reactions they received from some colleagues – especially the senior ones – when they announced that they wanted to pursue a career in psychiatry. A bit of humour is all very well, but behind this is something unacceptable – an implication that the best and brightest doctors are somehow wasting their time in psychiatry. This has to stop, and this campaign is going to do that. People with mental disorders – just like those with physical disorders – deserve the best minds to find new treatments and provide the best care.’ He will launch the campaign on Saturday 27 February at the National Student Psychiatry Conference 2016 in Edinburgh.”
Note the dictatorial tone: “This has to stop”!
And the grandiosity: “this campaign is going to do that.”
So the Royal College of Psychiatrists is launching a campaign that will stop medical students and trainee physicians from ribbing each other concerning their chosen specialties. Why not start with something easy, like world peace?
. . . . .
But there’s more! On March 2, BMJ Careers ran a piece on Dr. Wessely’s anti-bashing campaign. The article is titled Stop bashing psychiatry, royal college urges medical students. Here are some quotes:
“‘The current generation of students don’t put up with the things we used to,” Wessely told BMJ Careers. ‘Derogatory comments about race, sexuality, and gender are not common now, and when they do occur students complain. We want them to become the people who call others out when they denigrate psychiatry and mental health.'”
Isn’t that the most delightful piece of spin. So for a medical student or trainee physician to assert that psychiatry isn’t real medicine or that psychiatrists are not actual doctors is akin to slurs based on race, sexual preference, or gender. Equating interdisciplinary college banter with the exploitation, victimization, and at times downright savagery, that has in the past been directed towards the groups mentioned is, I suggest, insulting to the point of obscenity.
And isn’t it particularly interesting that a growing number of psychiatry’s former “patients” are recognizing that the “diagnostic” labels conferred on them by psychiatrists were (and are) inherently disparaging, disempowering, and stigmatizing, often permanently!
Dr. Wessely is essentially calling for a kind of thought police mentality in Britain’s medical schools. Students are encouraged to “call out” those who breach the code of silence by describing psychiatry as the unscientific non-medical hoax that it is.
. . . . .
“He [Dr. Wessely] added, “’I remember being told that I would be wasted in psychiatry because I was too smart. What that says is that mentally ill patients only deserve crap doctors.'”
No, Dr. Wessely, that’s not what it means. It means that psychiatry is a destructive, hocus-pocus, facile sorting activity which assigns so-called diagnoses, and distributes neurotoxic drugs to people whose problems are not medical in nature. It is not intellectually challenging to even a moderate degree. In fact, its primary requirement is the “ability” to systematically blind one’s cognitive capacities to its total lack of intellectual and conceptual rigor.
. . . . .
“As part of the campaign, the college will be working with mental health charities and medical school deans to drive home the message that bashing psychiatry is no longer acceptable, and Wessely will be visiting every UK medical school to discuss the issues.”
Visiting every medical school in the UK to stamp out interdisciplinary ribbing! What an extraordinary way for a person of Dr. Wessely’s stature to spend his time. Does he actually imagine that he can achieve this? Or that even if he did succeed in eradicating this kind of thing, that it would make the slightest difference to psychiatry’s status or to its ever-downward trajectory?
Perhaps we’re witnessing the death-throes of a profession. Locked irrevocably to a bio-bio-bio ideology; buffeted on all sides by critics, including some from within; and with no defense to the conceptual and practical criticisms, they tilt at the flimsy windmills of college banter in their futile drive to establish their medical bona fides. As if saying it often enough, and with sufficient conviction, will make it so.
. . . . .
But there’s more! Dr. Wessely’s campaign to exorcise anti-psychiatry banter has its own tee shirt!
As often happens in criticizing psychiatry, I don’t know whether to laugh or cry!