Contrary to their claims of doing so continually, psychiatrists do not treat known organic illnesses.
Organic illnesses come under the care of the medical specialties relevant to a particular organ or biological system. Known brain diseases and disorders come under the remit of neurology and neurosurgery. Emotional and psychological distress comes generally under the realm of psychology and the counselling professions. So where exactly does psychiatry fit in?
Psychiatrists have invented terms such as “mental illness” and “mental disorder,” the diagnosis and treatment of which is their bread and butter, their supposed area of expertise. They have fed the public with unsubstantiated ideas about neurotransmitters, chemical imbalances and brain disorders, ideas which the public have generally believed wholeheartedly. People generally trust doctors.
Most people – including the majority of doctors working in real medical specialties – are happy to let mental health doctors get on with it, assuming that they have the public interest primarily at heart. Few people realize that psychiatry is a house of cards without a solid scientific foundation that could easily crumble if properly and independently examined, and psychiatry’s position with it. One can therefore understand why psychiatrists might resist the questioning of their profession; there is a great deal at stake for them.
Mainstream psychiatry finds itself between a rock and a hard place, somewhere between the medical specialties that treat known brain diseases – neurology and neurosurgery – and the various forms of so-called “talk therapies,” including psychology and psychotherapy. The challenge for psychiatry has been to carve out its own distinct identity. Claims that depression and other psychiatric diagnoses are biological illnesses are crucial to psychiatry’s identity and its unmerited position at the top of the mental health pyramid. These assertions separate psychiatry from the talk therapies and ensure that psychiatry has first claim to these “diseases” and the people they diagnose as having them.
It is in psychiatry’s interest to be more closely aligned to neurology than to talk therapies, given neurology’s respected standing as a scientific branch of medicine dealing with biological brain disorders. But to maintain its own identity, psychiatry needs to be perceived as distinct from neurology. Specializing in “mental illnesses” and “mental disorders” provides the needed distinction, since neurologists do not treat “mental illnesses.” Mainstream psychiatrists have convinced the public – and perhaps themselves – that what they refer to as psychiatric disorders are biological illnesses. They get around the fact that there is no reliable corroborative scientific evidence for this by employing a number of strategies. These include misleading the public and perhaps themselves regarding the current state of medical knowledge through exaggeration and distortion of the facts, misrepresenting theories as facts, and confidently claiming that the assumed biological basis of depression will definitely be established at some time in the near future.
For over a century, psychiatry has reassured the public that both the necessary understanding and more effective solutions lie just around the corner. “Bear with us, we are almost there,” psychiatry’s catchphrase for the past 100 years and more, buys them more time, every time.
Positioned precariously between a rock and a hard place, psychiatry has so far managed to straddle this position with impressive dexterity. Actually, the current situation suits mainstream psychiatry’s priorities perfectly. Psychiatry has succeeded in persuading the public that it is different from psychology and psychotherapy, so that’s one side of the equation sorted. Maintaining their position in regard to neurology and other medical specialties is more delicate. Psychiatrists claim that the “diseases” they treat are fundamentally biological and that biological evidence is just around the corner. But psychiatrists know that it is neurologists and neurosurgeons – not psychiatrists – who treat brain diseases with known abnormalities of brain structure and function.
If brain abnormalities were ever actually identified in relation to psychiatric diagnoses, psychiatry would be presented with a potential nightmare scenario. If structural or functional brain abnormalities were ever found in relation to the psychiatric diagnoses, care of these people would immediately transfer away from psychiatry to a specialty that deals with known brain abnormalities, that is, to neurology or neurosurgery. As a member of the medical profession for over thirty years, I know that precedent rules within medicine. Precedent within the medical profession would dictate that the responsibility for these patients would immediately shift to neurology or whatever the relevant specialty might be. Regarding the experiences and behaviours that doctors have convinced the public should be called “depression,” this would mean that psychiatry would lose the majority of the patients who currently attend them. This would represent a catastrophe for psychiatry.
The most beneficial position for psychiatry is therefore the one that currently pertains. By claiming to nail its colours to the biological mast, psychiatry has successfully set itself apart from talk therapies. As long as no biological abnormalities are reliably identified, there is no threat that their bread and butter will be removed from them to other medical specialties. Maintaining the myth that biological solutions are just around the corner satisfies the public and maintains psychiatry’s position quite satisfactorily from psychiatry’s perspective, albeit between a rock and a hard place. This position has no solid scientific foundation, but as long as the public do not realize this and psychiatry does not attempt to encroach on the territory of other medical specialties such as neurology, psychiatry’s position is secure.
Psychiatry’s survival in its present form requires the delusion that is the disease-focused model of mental illness to remain supreme. Only then can psychiatry remain at the top of the mental health pyramid. The current biologically-dominated psychiatric model can only dominate if biology is accepted as the core issue without this actually being established. Having such a vested interest in and being so tied to a biological façade, the widely assumed scientific objectivity of mainstream psychiatry is in truth a mirage.
The bias in favour of biology that pertains within psychiatry is linked to psychiatry’s desire to stand out in the public mind as the experts on mental health. After all, if biology isn’t seen as central to the experiences and behaviours that have become repackaged as so-called “mental illnesses,” what special expertise can mainstream psychiatrists claim to possess?
When doctors defend their pronouncements on depression, bipolar, schizophrenia and other psychiatric labels, they are not just defending a diagnosis. They are defending themselves, their ideology, their modus operandi and ultimately, their status and role in society as the perceived prime experts in mental health. For doctors who have vehemently promoted the notion that, for example, depression is caused by a chemical imbalance or another brain problem as a fact or near-fact, belatedly acknowledging that this is not the case risks losing credibility.
GPs, or family physicians, also find themselves in a difficult situation, but it too is of their own making. The medical jacks-of-all-trades and masters-of-no-specialty other than general practice itself, within the medical hierarchical system family physicians are subservient to the supposedly superior expertise of psychiatry. Family physicians are often accused from many directions including some psychiatrists of overprescribing antidepressants and prescribing them for the wrong people. Conversely, some psychiatrists assert publicly that depression is a significantly underdiagnosed and undertreated condition, sometimes criticizing GPs for underdiagnosing depression.
Such contrasting positions do not occur with real biological diseases like diabetes, where objective clinical tests are a prerequisite to diagnosis, making the diagnosis of diabetes watertight scientifically. Family physicians are further criticized from several quarters for being a main driver of the explosion of antidepressant prescribing.
Such mixed messages put GPs in an invidious position. One can understand how some family physicians might feel they cannot win, being damned if they do and damned if they do not diagnose and treat depression. This uncomfortable juxtaposition is a case of the chickens coming home to roost, a direct consequence of assigning disease status to depression by deviating from longstanding medical standards regarding the definition of disease. Doctors created this problem by insisting that so-called “mental illnesses” are medical illnesses like any other, for which only doctors have the expertise to lead the way.
The vast majority of doctors do not possess anything like the expertise in mental health that the public believe they possess. Maintaining this delusion – a delusion of expertise – in the public mind is essential in order for medical mental health doctors to maintain their unmerited position as society’s most expert mental health experts.
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.