On October 13, an interesting article was published on the Huffington Post Blog. The author is Jessica Gold, MD, a psychiatry resident at Stanford University; the post is titled Inpatient Psychiatry: Not all Needles, Drugs And Locks.
The article is a personal experience/opinion piece, the gist of which is that people who criticize or condemn psychiatry simply don't understand the complexities and needs of psychiatry's "patients", particularly the need for locked wards.
The article is generally unremarkable in that the arguments adduced are well-worn by more senior psychiatrists. But it is interesting, and indeed tragic, to see a new entrant to the field absorbing psychiatry's defensive nonsense, and trotting it out uncritically for public consumption.
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Dr. Gold begins by describing the kinds of interactions she experiences in social settings when people learn that she is a psychiatrist.
"However, what frustrates me most are the times when after describing my day-to-day as a psychiatry resident, I am met with bewilderment, followed by misplaced sarcasm as I am asked, 'And why would you want to do that?'"
Dr. Gold then becomes reflective:
"After reminding myself not to get defensive (as I continued to do throughout writing this piece) or just stop the conversation completely, I became intrigued. While doctors may not evoke the same respect and adoration of the days of house visits, no one asks the other doctors (non-psychiatrists) in my family with such strong negative connotation why they chose their respective specialties.
I began to wonder if it’s because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient. Without knowing the safety rationale, it can feel degrading to have your clothes taken away, along with your cell phone, shoelaces, and sharp objects, only to sleep in a boring room with heavy, non-moveable (or throw-able) furniture. If you lack insight into your illness and do not understand the necessity of hospitalization, it can feel prison-like to be on a locked ward without the ability to leave it. And, without understanding the therapeutic benefit of engaging in connections with others on the unit, it can feel restrictive to have visiting hours and not be able to have a significant other or family member spend the night."
So Dr. Gold is frustrated by the sarcasm she encounters when social acquaintances discover that she is a psychiatrist, and notes that other medical specialties do not generally attract this kind of response. She wonders if the reason for this differential response might be:
"… because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient."
This is a truly delightful piece of self-deceptive spin. Psychiatry's so-called patients might well feel scared of locked wards, and understandably so. But the notion that fears of this sort underlie the general public's negative perception of psychiatry is arrant nonsense. The general public's negative perception of psychiatry, as compared to genuine medical specialties, is grounded in a realistic appraisal of psychiatry's spurious concepts and destructive "treatments". In particular, psychiatry is negatively perceived because:
- Psychiatry's definition of a mental disorder/ illness, as set out in DSM III, IV, and 5, embraces virtually every significant problem of thinking, feeling, and/or behaving. Psychiatry uses this definition to fraudulently medicalize problems that are not medical in nature.
- Psychiatry routinely presents these so-called illnesses as the causes of the specific problems, when in fact they are merely labels: abbreviated rewordings of the presenting problems with no explanatory function or value. These labels, which cause enormous damage to the individuals to whom they are assigned, serve only to legitimize the pushing of drugs, and to enable psychiatrists to bill for the services they provide. Unlike real diagnoses, they provide no insight into the nature or essence of the presenting problems, but are nevertheless defended tenaciously by psychiatrists and their pharma funders.
- Psychiatry has routinely deceived, and continues to deceive, their clients, the public, the media, and government agencies, that these vaguely defined problems are in fact illnesses with known neural pathology. The classic example of this is the chemical imbalance theory of depression – a blatant hoax which was pushed so heavily by psychiatry that it has now become "common knowledge". And the most noteworthy aspect of this is that although the hoax has been exposed repeatedly – (most recently by Terry Lynch in his book Depression Delusion), psychiatry has taken no concerted steps to correct this misinformation, and indeed in many quarters is still promoting this fiction as established medical fact.
- Psychiatry has blatantly promoted drugs as corrective measures for these illnesses, when in fact it is well-known in pharmacological and psychiatric circles that no psychiatric drug corrects any neural pathology. In fact, the opposite is the case. All psychiatric drugs exert their effect by distorting or suppressing normal brain functioning. It is also well known that the adverse effects of these products are often devastating and permanent.
- Psychiatry has collaborated and conspired with pharma in the development of a vast body of fraudulent research, all designed to "demonstrate" that psycho-pharmaceutical products are safe and effective. The methods by which this fraud has been perpetrated include: the routine suppression of negative results; the use of ridiculously short follow-up intervals; over-stating of marginal results; suppression of adverse effects; etc., etc.
- A great many psychiatrists have shamelessly accepted large sums of pharma money for very questionable activities. These activities include the widespread presentation of pharma infomercials in the guise of CEUs; the ghost-writing of books and papers which were actually written by pharma employees; targeting of captive and vulnerable audiences in nursing homes, group homes, and foster-care systems for prescription of psychiatric drugs; etc., etc… Two glaring examples of this kind of venality are:
- the promise made by psychiatrist Joseph Biederman to Johnson & Johnson that his research would produce a positive finding for their drug Risperdal, provided they ponied up $700,000 for a center on pediatric bipolar disorder at Harvard’s Massachusetts General Hospital.
- the promise, also to Johnson and Johnson, by psychiatrist Allen Frances and two colleagues (psychiatrists John Docherty and David Kahn) that they would produce a document on schizophrenia treatment guidelines that would help Janssen (Johnson & Johnson subsidiary) succeed in its effort to "increase its market share and visibility" for their drug Risperdal "in the payor, provider, and consumer communities." (Rothman Report, p 15-16)
In this context, it should be noted that Dr. Biederman and Dr. Frances are among the most eminent and prestigious psychiatrists in the US.
In addition, 70% of the DSM-5 task force members had received funding from the pharmaceutical industry.
- Psychiatry's labels are inherently disempowering. To tell a person, who in fact has no biological pathology, that he has an incurable illness, for which he must take psychiatric drugs for life, is an intrinsically disempowering act which robs people of hope, and encourages them to settle for a life of drug-induced dependency and mediocrity.
- Psychiatry's "treatments", whatever transient feelings of well-being or tranquilization they may induce, are always destructive and damaging in the long-term. Neuroleptic drugs cause tardive dyskinesia. Extended use of antidepressants produces a state of chronic joylessness. Benzodiazepines are addictive. High-voltage electric shocks to the brain erase memories. Psychiatry's notion that one can solve people's problems by tinkering irresponsibly with their brains, betrays a degree of arrogant naivety unequalled in other professional groups.
- Psychiatry's spurious and self-serving medicalization of every significant problem of thinking, feeling, and/or behaving, effectively undermines human resilience, and fosters a culture of powerlessness, uncertainty, and dependence. Powerful, time-honored concepts such as the need for critical self-appraisal, and personal improvement through effort, have been systematically marginalized by psychiatry's expanding list of "illnesses", and ever-flowing supply of drugs. Relabeling as illnesses, problems which previous generations accepted as matters to be addressed and worked on, and harnessing billions of pharma dollars to promote this false message, is morally and professionally repugnant.
- Psychiatry's primary agenda over the past four or five decades has been the expansion of its list of "illnesses", and the assignment of these illnesses to more and more people. It has now become routine practice to prescribe neuroleptic drugs to elderly nursing home residents who become "unmanageable", and to young children for temper tantrums!
This is the profession that Dr. Gold chose to enter and now chooses to defend with patronizing platitudes.
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Back to Dr. Gold's paper:
"Dear future and past patients: I. COMPLETELY. GET. IT. Nothing about being on a psychiatric ward is typical, even for a medical setting. But I (and every nurse, social worker, psychologist, occupational therapist, physical therapist, nursing assistant, and physician I have ever worked with) also really want to help you. That is why I chose a career in medicine, and even more true of the reason why I chose to specialize in psychiatry. I worry the images you have of inpatient psychiatry scare you and prevent you from seeing me as an ally. Even when I tell you that I am here to help, I can see the skepticism in your eyes and hear the fear in your voice. I am trained to observe, after all.
It is not surprising, then, that when I read descriptions or see my job portrayed as forceful or horrific, I want to take the time to correct them. I am not doing this simply because I want to protect my profession, but am actually doing this in defense of and in support of anyone who might need mental health help in the future. Stigmatizing attitudes toward psychiatric illnesses already exist; fear of psychiatry and seeking care do not need to be added to the equation."
In recent years, the psychiatric survivor movement has grown, both in numbers and in the volume of output. Survivors are writing about the mistreatment they have received, often for decades, at the hands of psychiatry. But Dr. Gold dismisses these protests as erroneous and misinformed over-reactions. Psychiatry's so-called patients: "lack insight" into their illnesses; do not understand "the necessity of hospitalization"; do not understand "the therapeutic benefit of engaging in conversations with others on the unit"; don't realize that the psychiatrists who authorized the forcible injection of akathisia-inducing drugs "really" want to help; etc..
And Dr. Gold is taking the time to correct these misperceptions, not simply because she wants to protect her profession (Heavens, no!), but rather in defense and support of anyone who might need psychiatric help in the future. How noble!
"Maybe people will always fear psychiatry, mental illness and what they do not know…But maybe those attitudes can be changed and as mental health advocates, we need to do everything we can to assuage those fears. Unfortunately, even well-meaning former patients perpetuate those fears, whether inadvertently or because of the limited lens through which they viewed their own hospitalization."
To which I might respond: Even well-meaning psychiatrists perpetuate these fears, whether inadvertently or because of the erroneous and destructive disease-focused lens through which they view their "patients" and their "treatments".
The rationalizations and self-justifications continue:
"I’ve been screamed at, cursed at, rushed towards, demeaned and have seen patients and nurses get seriously injured. Even still, I do not make these decisions lightly or lead a conversation with a needle."
The great irony here is that the neuroleptic drugs that psychiatrists routinely use to control aggressive behavior frequently produce a condition called akathisia, which in turn is a known precipitator of suicide and violence. Crowner, Douyon, et al, conducted a short study of this matter in 1990. Here's a quote from their paper:
"Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed."
It would be interesting to know how many of the individuals who screamed, cursed at, rushed towards, and demeaned Dr. Gold were experiencing akathisia as a result of neuroleptic or antidepressant drugs that she had prescribed for them. It is also interesting that no major follow-up of the Crowner, Douyon, et al study has been undertaken by psychiatry.
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"Given the responses to our career selection in casual conversation, it is probably not shocking that I (and my peers) can sometimes hesitate to say my medical specialty, despite having no shame or regrets about my decision. Knowing now that hiding my profession only further contributes to its stigma, and without a voice or a face, psychiatrists and their patients will always just be a part of a power struggle…, I will never again shy away from it:
I am a psychiatrist-in-training. My job is complicated, weird, unique, fun, fulfilling, and challenging… but that’s what makes it beautiful."
Well all of this is nice to know, but in my view, psychiatry is neither fun nor fulfilling for those on the receiving end, especially in the long-term..
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The reality is that psychiatry is not something good that needs some minor corrections. Rather, it is something fundamentally flawed and rotten; a wrong turning in human history, trailing death, disability, and disempowerment in its worldwide wake. No amount of rationalization or platitudinous exculpations can mitigate this reality. Psychiatry kills people every day, and adamantly refuses to recognize this reality and take appropriate action.