The faults of modern psychiatry are numerous and profound, and many readers here know firsthand about its destructive force. But are these faults so vast that there is nothing worth saving?
Bonnie Burstow has suggested that facts lead to “the inescapable conclusion that psychiatry has no foundation and should be phased out” Elsewhere she has written about “psychiatry’s utter invalidity” and suggested that reform cannot work, as it will be inevitably coopted.
Philip Hickey has also supported an “anti” psychiatry perspective, suggesting that psychiatry is now “so rotten and flawed that anti is the only appropriate stance consistent with human decency.”
I am sympathetic to these arguments, but I am also concerned they may be too extreme to be practical in a world that could still benefit from a medical specialty focused on mental and emotional problems.
Of course, I don’t mean at all to say that mental and emotional problems are typically “medical” in nature, as I believe they more commonly are simply reactions to difficult events or environments, which can in turn be worked through with some human understanding and non-medical assistance.
But I would propose there are three legitimate roles for a medical profession specializing in issues related to the mind and behavior:
First, even for conditions with causes unrelated to anything medical, it may still be helpful to have a medical intervention at some point to cope with the difficulties. For example, a manic episode, with severe loss of sleep, may not be due to specifically “biological” causes, but it still may be helpful to have a medical person who can recommend appropriate drugs to moderate the episode before more disasters ensue. (It is true that a general practitioner might also propose particular drugs, but it seems reasonable that we have medical specialists who can give more expert advice around such issues.)
Second, even though most mental and emotional problems may be primarily caused by social and psychological factors, others may have a specific medical cause. So there is a possible place for medical specialists who would be skilled at identifying these kinds of cases so people can get appropriate help. And even when the primary cause of a problem may be non-medical, it is still possible that medical factors may be contributing to vulnerability or to making the problem worse, and so there is a possible place for medical people with expertise in identifying such factors and proposing helpful interventions.
Third, even when mental and emotional conditions have non-medical causes, those conditions can lead to medical problems, and this chain of events is a legitimate area of medical concern. It appears for example that adverse childhood events frequently lead to mental and emotional reactions that then lead not just to “mental health” problems later in life, but also to physiological reactions that then lead to much higher rates of physical illness. Medical specialists with understanding of these dynamics could be helpful in better addressing some of these serious health issues.
[Edit added later: As madmom suggested in the comments, a fourth role could be to support people in efforts to wean off of psychiatric drugs.]
So, that’s three [four] arguments for continuing to have a medical specialty focused on “mental health” – but it’s really not an argument in support of modern psychiatry which actually does a very poor job of addressing these three areas of concern, due sometimes to over-reach, and sometimes to neglect.
The over-reach is most glaring. Instead of carefully exploring individual problems, being open to the possibility of medical causes but also to psychological and social ones, and keeping in mind that many problems might best be solved without medical interventions, mainstream psychiatrists prefer to quickly assign people to categories or labels, assume based on the label that it must be a biological illness, and then rush to prescribe drugs with little attention to risks, possible long term problems, or possible alternatives.
On the neglect side, there is often a failure to carefully look for objectively identifiable physical health conditions that might truly contribute to vulnerability, or nutritional factors, or problems with intestinal bacteria that may contribute to inflammation, etc. Physical health problems caused by mental and emotional issues, and those caused by the drugs provided for treatment, are also commonly neglected.
In fact, the problems with modern, mainstream psychiatry are so vast that one might argue we would be better off just eliminating it as a profession, and then creating an entirely new medical specialty that would do things differently. Others might argue that simply reforming the profession would be more doable. I won’t take a position on that: I am just asserting both that we do need medical expertise in the field of mental health, and it needs to be very different from what we have now.
One psychiatrist who has put a lot of thought into what sort of medical approach might be truly helpful is Sandra Steingard.
She has proposed that a better psychiatry would be “slower” (kind of like the “slow food” movement.)
This “slowness” might show up in a number of ways:
- Slower to be sure one knows what is wrong with someone, wanting to know the person as a complex individual, not just a category
- Slower to assume that a situation is an emergency and requires any kind of force
- Slower to propose drugs as a solution
- Slower to be sure drugs will help, instead proposing that they will create a “drugged state” that may help or may not
- Or that may seem to help for a bit and then make things worse
- Slower and taking more time in explaining possible risks, and in proposing possible alternatives.
A psychiatrist practicing in this way would come across as much more humble, but also wiser.
It’s interesting that “jumping to conclusions” is a trait commonly identified as contributing to psychosis, yet is also so prominent in the practice of mainstream psychiatry. So slowing down may be helpful, not just for the patient, but also for the physician.
Are you curious to hear more about how a “slower psychiatry” would work? Sandra Steingard will be speaking at the next ISPS-US online meeting/webinar on Monday, 5/23/16, 4:30 PM EDT. A small donation is requested, but there is also an option to sign up for free. I hope some of you show up to hear about and discuss this important topic! Here’s the link for more information and to register.