Psychiatry: Between a Rock and a Hard Place

Terry Lynch, MD
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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.

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39 COMMENTS

  1. Yep.

    …and I’d add that in their ignorance and pretence of knowledge, both GPs and psychiatrists are doing massive damage as they really have very little to offer “depressed” or otherwise “mentally ill” patients other than stigma, trauma, and an addiction (often by force) to very dangerous drugs.

    They should only be diagnosing and medicating biologically identifiable conditions. As it is, they are imprisoning and forcibly drugging and/or shocking distressed people without any evidence base simply because, as doctors, they have the power to do so.

    It is horrendous. Thank you for speaking out.

    • ..and I should add, that they never even thought to conduct thyroid tests on me BEFORE putting me on dangerous drugs. It was only a few years down the track that a doc actually ordered a thyroid function test and discovered a problem.

      Diagnosing a fictitious “mental illness” likely meant a real physical illness that was perhaps the cause of my struggles went untreated.

  2. The case for inflammation playing a prominent role in depression and anxiety is becoming more greatly accepted. Andy Miller and Chuck Raison have been exponents for this position. Bloggers on this web sit, including Kelly Brogan and myself, have advanced this case. Brain inflammation and activated microglia also may be the cause of psychosis. (See the blog at my website littrellsneuroscienceofwellbeing.org. or my book Neuroscience for Psychologists and Other Mental Health Profesisonals.) At the Biological Psychiatry meeting in May of this year, Tony Grace and Kim Do presented on inflammation and psychosis. The psychiatrists may find a physical basis for symptoms, but the immunologists are the relevant specialty. The treatments will heavily involve diet.

    • Jill,
      There is no “the cause” of psychosis – there is “a cause” (for an individual in a particular situation) or many different causes when looked at from the 30,000 foot view.

      Inflammation itself can mean a variety of different things, refer to different parts of the body, vary in degree over time, and be caused by a multitude of different prior causes. So overfocusing on inflammation as if it is one unitary thing is as unlikely to lead to clarity as focusing on “depression” or “schizophrenia” as if these were unitary illnesses. Inflammation (of what?) is more likely just a follow-on of other earlier causes, just as varying dopamine levels in the brain is not a first cause (of schizophrenia or anything else). I’m surprised this is not more obvious to you.

      Furthermore, depression and anxiety are syndromes, not discrete diseases.

      I agree with oldhead about the circular thinking and correlation-causation confusion in your comment.

    • Theron Randolph, an early allergist, pioneered these efforts through his study of what he called cerebral allergies. Back in the 1950’s, he treated a number of psychiatric patients by water fasting them until they became symptom free and tested them by reintroducing certain foods one at a time until the patients had symptomatic reactions to one or more of the test foods. The fasting time usually ran from 4 to 8 days. The Big Time Psychiatric wheels were most uninterested when he presented data on 2,000 patients at an APA meeting around 1960.

    • Yes, @Jill Littrell, wonderful to see the work being done by Integrative and Functional medicine on the interplay between inflammation, our biological systems (bacteria, gut, hormones,…), and our feelings and behaviours. Advances have been practically helpful for me as a parent feeding and educating kids (one of whom experiences behavioural difficulties). I first encountered Kelly Brogan through her interviews on free, online Integrative ‘summits’ (where I also first heard neurologist David Perlmutter and his experience seeing a child cleared of Tourette’s through fecal transplant, and discovered people like Datis Kharrazian) and was thrilled when she appeared on MIA. It’s great to see these two worlds starting to overlap.

  3. The point becomes even more obvious when you realize in the 20th Century’s two great examples of preventive psychiatry, disappearances of general paresis (neurosyphilis) and pellagra from mental institutions, psychiatry and psychiatrists played no role.

  4. Dear Dr Terry,

    I get a lot of clarity from your writing.

    I thought mental illness was a figure of speech until I met doctors and nurses that promoted Mental illness as a genuine illness – and got upset if they were disagreed with.

    But if Mental illness is not an illness then the doctors and nurses are being paid professional salaries for disabling people.

    • I’ve experienced both the medical approach and the nonmedical approach. The medical approach was very unsuccessful.* But the psychotherapy approach was completely successful.

      *(After 4 years of hospitalizations, suicide attempts and disability I was diagnosed worse than I had been at the beginning).

    • “But if Mental Illness is not an illness then doctors and nurses are being paid professional salaries for disabling people.”

      I came to that conclusion, appalling as it is. I have a vested interest in getting well. Unfortunately, the psych profession has a vested interest in keeping us all sick. 🙁

  5. It’s good to see a physician say what I’ve been noticing for some time. Psychiatrists place so much emphasis on biology, not because they have found any biological root to “mental disorder”, but because it serves their professional career interests to do so. There is practically a taboo against suggesting that there isn’t a biological basis to “mental illness” labels within the psychiatric profession at the present time, and this because, as you put it, without that biological conjecture, psychiatry is “between a rock and a hard place”. Physic is what physicians are all about. Psychiatrists, on the other hand, are all about psych or soul. There is a vast difference between the two. Claiming that psych is physic doesn’t make it so. There is also a vast difference between science and religion, and I don’t think psychiatrists are anywhere near close to alleviating it.

  6. Thank you, Dr. Lynch, for speaking out against the “delusion of expertise” being fraudulently alleged by today’s psychiatric profession and GPs, to the detriment of the majority within humanity. Both in terms of the extreme harm being done to millions of patients, especially when it comes to the drugging of children and medically unnecessary forced treatments. But also in terms of our society being forced to pay, in the tune of billions, for failed research into these unproven DSM “mental illnesses” and the resulting psychotropic “treatments,” which are proving to do more harm than good.

    I have been an independent “mental health” / pharmaceutical industry researcher for over a decade now, and would like to say if you are truly interested in understanding the “nature” of so called “mental illnesses,” like “bipolar” and “schizophrenia,” you need to take an honest look at the adverse effects of the drugs and recommended drug cocktails prescribed for these so called conditions, which the psychiatric profession as a whole seems completely incapable of honestly doing.

    For example, here are today’s “gold standard” treatment guidelines for “bipolar”:

    http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544

    If you note, it’s highly recommended that treatments for “bipolar” include combining the antidepressants and antipsychotics. This, despite the fact, I believe every MD learned back in med school about anticholinergic toxidrome, which can result from combining the antidepressants and antipsychotics.

    https://en.wikipedia.org/wiki/Toxidrome

    And these are the central symptoms of anticholinergic intoxication syndrome from drugs.com:

    “Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    The only difference between the central symptoms of anticholinergic toxidrome, and the positive symptoms of “schizophrenia” is “hyperactivity” vs. “inactivity.” And since anticholinergic toxidrome is not listed in the DSM as a possible cause of ‘psychosis’ and these other symptoms, it is almost always misdiagnosed as one of the billable DSM disorders. Out of sight, out of mind, right?

    And the neuroleptic drugs alone can create the negative symptoms of “schizophrenia,” as well as the positive symptoms of “schizophrenia,” as pointed out above. The negative symptoms of “schizophrenia” can be created via NIDS:

    https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome

    The truth of the matter seems to be that today’s DSM is a classification system of the iatrogenic illnesses created with the psychiatric drugs, rather than a classification system of “biological” or “genetic” illnesses. I do understand this is a “bitter pill” for the psychiatric industry to swallow, which has led to a tremendous amount of cognitive dissidence within that field today.

    But it’s important all people, including the psychiatrists, overcome our “delusions,” and learn to coexist in a mutually respectful manner with the rest of civilization. I realize defaming people with scientifically invalid and unreliable “mental illnesses,” then making people sick with the psychiatric drugs, is easy and very profitable. However, it is also morally repugnant behavior on the part of the psychiatric industry, and GPs who are doing this. Again, thanks for speaking out against the “delusion of expertise” being fraudulently alleged by today’s psychiatric profession and GPs.

  7. Without even reading any other comments I can say that this is one of the most valuable, accurate, and to the point articles I’ve seen on MIA all year. I can literally find nothing here to seriously challenge other than perhaps the author’s tentative use of the phrase “mental health” itself. (I guess I also question why Dr. Lynch still identifies himself as a “mental health” expert instead of something else, though I know the system was in place long before he entered it. But this is secondary.)

    Regarding GP’s, I believe they must be feeling some pressure from the feds to start identifying people as “depressed,” as this is apparently going to be a neoliberal strategy for taking people’s guns away.

  8. Excellent article, Dr. Lynch. It says exactly what needs saying. I’m not a medical professional, but I am a medical writer, and I’ve lost count of the many articles I’ve read in which the author solemnly states that a particular medication is hte “gold standard” for a “disease” such as anxiety. What is also troubling is the way patients welcome this kind of diagnosis – they’re glad to be told they have an illness, which allows them to hand off the problem to a psychiatrist who will make it all better. I’m not dismissing the very real nature of their pain, but that removes any other options for resolving it. It’s more comforting to believe you’re sick in the same way as someone who has diabetes or a heart condition – and psychiatry so unfairly reinforces this paradigm.

  9. Terry,
    Thank you for your excellent article. It is indeed stunning when one examines and understands how little science underlies the diagnostic categories and treatments employed by most psychiatrists. “House of cards” describes the situation perfectly.

    A few years ago under a pseudonym I wrote an article echoing many of your themes and exposing the lack of science behind one of psychiatry’s primary “severe” diagnoses, Borderline Personality Disorder:

    https://bpdtransformation.wordpress.com/2014/03/16/the-science-of-lies-psychiatry-medication-and-bpd/

    I called it the Science of Lies, after Szasz. It is an apt term for this field, although many psychiatrists do not actually know or intend to mislead and harm, contrary to how it sometimes appears to those of us who get drugged or coerced.

    One must wonder how many more influential people and groups need to become more aware of the spurious nature of psychiatric diagnosis and treatment in order for more profound change to happen, for a tipping point to be reached. The last few years have not been good for psychiatry in terms of its public image, although treatment in many areas continues largely unchanged.

    This makes me think of the law of the vital few, aka the Pareto Principle: https://en.wikipedia.org/wiki/Pareto_principle

    Anyway, good article and well done for writing this.

  10. I guess the lure of profit and wealth from negligence, fraud and slander must be too much for some to bear. A rock and a hard place? This is exactly where the traducers belong, and “Indeed, Hellfire will be closed down upon them. In extended columns”

  11. dr terry,

    i really loved the way you broke this down. by now i’ve read hundreds if not thousands of articles on this topic, and i have my own horrific lived experience. this is a first, thought, to show it this way: they claim again and again that anxiety and other distressing items are biologically based. however, if a cause of distress is actually found to be a biological anomaly, the patient is handed off to a REAL doctor.

    i love it! i pray for the day the world wakes up to the truth. keep up the awesome work!

    -erin