The “Essential Principles” of Psychiatric Practice: More Psychiatric Cheerleading

Philip Hickey, PhD
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In the May 2018 issue of Current Psychiatry, there’s an editorial by Henry Nasrallah, MD. Dr. Nasrallah is a highly renowned psychiatrist, and is editor in chief of the journal. He is also chair of the St. Louis University Department of Psychiatry.

Here’s the opening paragraph of the article.

“As the end of the academic year approaches, I always think of one last message to send to the freshly minted psychiatrists who will complete their 4 years of post-MD training. This year, I thought of emphasizing the principles of psychiatric practice, which the graduates will deliver for the next 4 to 5 decades of their professional lives. Those essential principles are coded in the DNA of psychiatric practice, just as the construction of all organs in the human body is coded within the DNA of the 22,000 genes that comprise our 23 chromosomes.”

So, Dr. Nasrallah wants to set down the “principles of psychiatric practice” by way of encouragement to “freshly minted” psychiatrists. It is not unusual for the more senior members of a profession to pass on what they perceive to be important precepts to the newcomers, but the DNA metaphor strikes me as bordering on bizarre. We can’t change our DNA, and there is, I think, in Dr. Nasrallah’s metaphor a suggestion that the newcomers can’t (or perhaps must not) change the principles on which current psychiatric practice is based. In addition, the term “freshly minted” strikes me as slightly insulting, as if they were coins being stamped out of a mint: each identical to the next. But I’m sure that Dr. Nasrallah knows more about newly-qualified psychiatrists than I do, so perhaps he’s right. Perhaps the culture and direction of psychiatry schools is geared to the production of drug-prescribing automatons programmed to ignore obvious facts and realities of human life, and to see instead clusters of “symptoms” that need to be “treated” with neurotoxic drugs and high-voltage electric shocks.

In the next paragraph, Dr. Nasrallah repeats the DNA metaphor:

“So here are the principles of psychiatry that I propose govern the relationship of psychiatrists with their patients, encrypted within the DNA of our esteemed medical specialty:”

One of the meanings of “encrypted” is difficult to discern, and as the principles in question are highly flattering to psychiatry and psychiatrists, readers might find the term more apt than Dr. Nasrallah has intended.

Also note the phrase “esteemed medical specialty,” which inevitably raises the question:  esteemed by whom? In reality, psychiatry, as the illustrious Jeffrey Lieberman, MD, pointed out in 2015, is the only medical specialty that has its very own anti-group. It is also noteworthy that the size and impact of this anti- group is growing exponentially, as the nature and scope of the psychiatric hoax is being increasingly exposed.

Dr. Nasrallah provides a list of twenty-seven principles. Most of them are tawdry, self-serving platitudes which most critics of psychiatry will find unworthy of credit. Here are some examples:

. . . . . . . . . . . . . . . .

“Provide total dedication to helping psychiatric patients recover from their illness and regain their wellness.”

. . . . . . . . . . . . . . . .

“Maintain total and unimpeachable confidentiality.”

. . . . . . . . . . . . . . . .

“Demonstrate unconditional acceptance and respect to every patient.”

This might be a little challenging for a profession that routinely conceptualizes its clients’ statements as symptoms, and where ultimately all interactions are conducted under the threat of involuntary commitment.

. . . . . . . . . . . . . . . .

“Adopt a nonjudgmental stance toward all patients.”

Unless, of course, the “patient” decides to stop taking the pills.

. . . . . . . . . . . . . . . .

“Provide evidence-based treatments first, and if no response, use unapproved treatments judiciously, but above all, do no harm.”

The contradiction here is glaring. All psychiatric “treatments” do harm. Electric shocks cause memory loss. Benzodiazepines and SSRI’s are addictive. There is abundant prima facie evidence that the SSRI’s are implicated in the murder-suicides, but psychiatry refuses to conduct a definitive study of the matter. And, of course, the permanent and disfiguring harm done by neuroleptics has been known for decades. In real medicine, the injunction to do no harm has genuine significance. In psychiatry, it’s an empty slogan. Whatever marginal benefits the drugs and shocks might confer in the short term are almost always eclipsed by the long-term harm, which in many cases is truly devastating.

. . . . . . . . . . . . . . . .

“Establish a strong therapeutic alliance as early as possible. It is the center of the doctor–patient relationship.”

. . . . . . . . . . . . . . . .

“Educate patients, and their families, about the illness, and discuss the benefits and risks of various treatments.”

In other words, tell them the falsehood that they have an illness, even though there is no evidence to support such a contention. And “…discuss the benefits and risks of various treatments.” And remember, these principles aren’t just exhortations to psychiatry’s newcomers; rather, they are, according to Dr. Nasrallah, the principles that underpin and drive current psychiatric practice; the principles that are coded in the DNA of psychiatric practice today! Well I have to say that in my experience, the great majority of psychiatrists routinely overstate the benefits of the drugs and shocks, and understate the risks. In fact, I have even encountered psychiatrists who cautioned against informing clients of the risks of tardive dyskinesia and akathisia with neuroleptic drugs, on the grounds that nobody would agree to take them if they received this information! And in this regard, it is noteworthy that on May 12, 2017, Columbia’s Psychiatry Department, under the leadership of the renowned and scholarly Dr. Lieberman, issued the following statement in a press release titled Benefits of Antipsychotics Outweigh Risks, Find Experts:

“An international group of experts has concluded that, for patients with schizophrenia and related psychotic disorders, antipsychotic medications do not have negative long-term effects on patients’ outcomes or the brain. In addition, the benefits of these medications are much greater than their potential side effects.” [Emphasis added]

The press release — including this blatant falsehood — was picked up by the media and printed by various news outlets, including UPIScience Daily, and Medical News Today, all of which repeated the Columbia assertions more or less uncritically. Perhaps Columbia’s psychiatry department hasn’t got the genuine psychiatry DNA!

. . . . . . . . . . . . . . . .

“Do not practice ‘naked psychopharmacology.’ Psychotherapy must always be provided side-by-side with medications.”

Whilst I am sure there are some psychiatrists who offer talk therapy to their clients, I believe their numbers are very small indeed. It is certainly not one of the “essential principles” of current psychiatric practice, as Dr. Nasrallah contends. And if readers are wondering why this is the case, Gardiner Harris’s New York Times article “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” (March 2011) provides some insights.  And even the most venerable Dr. Lieberman acknowledges this reality in his article “Change, Challenge and Opportunity: Psychiatry in the Age of Reform and Enlightenment” (2013). Here’s what he wrote:

“In the past few decades, the focus has shifted more toward the brain and away from the mind. And changes in reimbursement systems today have rewarded hurriedly written prescriptions and encouraged psychotherapy to be provided by nonpsychiatrist therapists. Paperwork, insurance procedures, and government regulation have stretched physicians’ tolerance and limited the opportunities for meaningful interaction with patients.” [Emphasis added]

Note how the admission of “hurriedly written prescriptions” is effectively nullified by shifting the blame to “changes in reimbursement systems,” and “Paperwork, insurance procedures, and government regulation.” Psychiatrists would love to have more meaningful interactions with their customers, but they just can’t, because — well it cuts into the bottom line! Poor lambs. Oh to be torn between greed and duty.

Douglas Mossman, MD, a psychiatrist at the University of Cincinnati, wrote Successfully navigating the 15-minute ‘med check’ (2010). Here’s a quote:

“Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”

And in 2017, Mark Moran, a senior reporter at the APA, wrote a piece for Psychiatric News in which he stated:

“The 15-minute medication management visit has become one of the standards of psychiatric practice.”

In the article, Mr. Moran quotes extensively from William Torrey, MD, a psychiatrist who laments the fact that the 15-minute med check has become the norm in psychiatric practice. But in reality, psychiatrists who are dissatisfied with this state of affairs have no one to blame but themselves. They vigorously promoted the deception that all significant problems of thinking, feeling, and/or behaving are illnesses which need to be corrected by drugs and electric shocks; they established themselves as the experts in the diagnosing of these fictitious illnesses and in the prescribing of the drugs and shocks; and they streamlined the process to maximize their earnings.

Is Dr. Nasrallah seriously contending that the provision of psychotherapy side-by-side with “medications” is standard practice in psychiatry today?

. . . . . . . . . . . . . . . .

“Support the patient’s family. Their burden often is very heavy.”

In some cases, this might be reasonable enough, but there is no recognition that the burden that family members sometimes impose on the client can be equally heavy.

. . . . . . . . . . . . . . . .

“Emphasize adherence as a key patient responsibility, and address it at every visit.”

And, of course, adherence means take your pills and electric shocks as the doctor ordered.

Although in this context of providing encouragement to “freshly minted” psychiatrists, Dr. Nasrallah is stressing the need for adherence, and, by implication, the value of the “treatments,” he was less enthusiastic about the drugs in an earlier article “The Dawn of Precision Psychiatry,” (December 2017). Here are some quotes:

“So, while clinicians go on with the mundane trial-and-error approach of contemporary psychopharmacology, psychiatric neuroscientists are diligently deconstructing major psychiatric disorders into specific biotypes with unique biosignatures that will one day guide accurate and prompt clinical management.” [Emphases added]

“Precision psychiatry will ultimately enable practitioners to recognize various psychotic diseases that are more specific than the current DSM psychosis categories. Further, precision psychiatry will provide guidance as to which member within a class of so-called ‘metoo’ drugs is the optimal match for each patient. This will stand in stark contrast to the chaotic hit-or-miss approach.” [Emphases added]

So, current psychiatric practice is a chaotic, hit-or-miss approach. Nevertheless, Dr. Nasrallah stresses the need for adherence on the part of the customer to the drugs prescribed through this hit-or-miss approach.

“Precision psychiatry also will reveal the absurdity of current FDA clinical trials design for drug development.” [Emphasis added]

“Precision psychiatry will completely disrupt the current antiquated clinical paradigm, transforming psychiatry into the clinical neuroscience it is.” [Emphasis added]

So, back in December of last year, when Dr. Nasrallah was promoting his fanciful vision for the future of psychiatry, he was extremely critical of the “current antiquated clinical paradigm,” but when welcoming “freshly minted” psychiatrists into the fold and encouraging them to embrace the essential principles of current practice, no intimation was given that the current principles are hit-or-miss, antiquated, and chaotic. I wonder if Dr. Nasrallah informs his customers that current psychiatry is hit-or-miss, antiquated, and chaotic. I wonder if, when he is emphasizing adherence (at every visit, remember?), he informs his customers that the prescriptions, to which they are being enjoined so vigorously to adhere, stem from a system that is hit-or-miss, antiquated, and chaotic.

. . . . . . . . . . . . . . . .

“Uphold the medical tenet that all ‘mental’ disorders of thought, mood, affect, behavior, and cognition are generated by disruptions of brain structure and/or function, whether molecular, cellular, or connectomic, caused by various combinations of genetic and/or environmental etiologies.”

This is unadorned bio-bio-bio psychiatry. All “disorders” of thinking, feeling, and behavior are caused by disruptions of brain structure or brain function! And don’t be misled by the word “environmental.” All that Dr. Nasrallah is conceding here is that some of the putative disruptions of brain structure/function may be due to environmental factors. This is a far, far cry from the reality that the great majority of thinking, feeling and behavior problems that psychiatry considers symptoms are in fact not the result of neurological “disruptions,” but rather are reasonable and understandable responses to current and historical losses, adverse experiences, and adverse circumstances (including, incidentally, the adverse circumstance of becoming enmeshed in the psychiatric system). It also needs to be pointed out that, apart from those problems described as due to a general medical condition or the effects of a substance, none of psychiatry’s so-called mental disorders has been consistently and causally linked to any defined disruption of brain structure or function.

And note the word “tenet,” which my New World Dictionary renders as: a principle, doctrine, or belief held as a truth, as by some group — synonym: doctrine. The critical point being that a tenet is a principle that is held to be true without evidence.

What Dr. Nasrallah is effectively conceding here is that the bio-bio-bio brain illness perspective

  • Is the philosophy underpinning psychiatry (encrypted in its DNA, no less!)
  • Is unproven (it’s a tenet, remember?)
  • Is to be foisted on the “freshly minted” psychiatrists who will be entering the work-force this year (“Uphold the medical tenet…!”)

. . . . . . . . . . . . . . . .

“Learn and use clinical rating scales to quantify symptom severity and adverse effects at baseline and at each visit. Measuring the severity of psychosis, depression, or anxiety in psychiatry is like measuring fasting glucose, triglycerides, or blood pressure in internal medicine.”

Psychiatric rating scales are always subjective. Measurements of glucose, triglycerides, and blood pressure, by contrast, are objective. Pretending that these very different kinds of assessments are comparable is just one more facet of the psychiatric hoax. Blood glucose measures are an essential part of diagnosing and managing diabetes. So the assertion that a scale for assessing depression (say) is “like” a glucose test is essentially equivalent to the long-touted but false assertion that depression is an illness, just like diabetes, for which one must take pills, often for life. The purpose of psychiatric rating scales is to convey the impression that some kind of scientifically valid assessment is being conducted before, during, and after “treatment.” But this impression is false. In reality there is no definition of any psychiatric “disorder” that would meet scientific standards. The fundamental assumption of psychiatry, that all significant problems of thinking, feeling, and/or behaving are brain illnesses, is simply false. Depression, for instance, far from being a neurological disorder, is the normal, adaptive human response to loss or adverse circumstances. Its evolutionary purpose is to alert us to the need to make some changes in our lives or circumstances.

. . . . . . . . . . . . . . . .

“Advocate tirelessly for psychiatric patients to increase their access to care, and fight the unfair and hurtful stigma vigorously until it is completely erased. A psychiatric disorder should have no more stigma than a broken leg or peptic ulcer, and insurance parity must be identical as well.”

Note: “increase their access to care,” the inevitable corollary of which is: more business for psychiatry. Bring us your huddled masses, and we will sell them drugs to fix their brains, even though their brains aren’t broken. If they stay on the drugs and shocks long enough, however, their brains will be broken.

Also note: “fight the unfair and hurtful stigma,” when in fact psychiatry’s groundless and unproven illness tenet is the major source of stigma for those hapless individuals who get caught within its web (Angermeyer et al, 2011Deacon, BJ, 2013Read, J, et al, 2006).

. . . . . . . . . . . . . . . .

“Recognize that every treatment you use as the current standard of care was at one time a research project. Know that the research of today is the treatment of tomorrow. So support the creation of new medical knowledge by referring patients to FDA clinical trials or to National Institutes of Health–funded biologic investigations.”

This reminds me of something that Carl Elliott, Bioethics Professor, University of Minnesota, wrote for Mother Jones back in 2010:

“Research subjects are the most highly prized commodities in the clinical trials industry. Four out of five clinical trials are delayed because of difficulties recruiting subjects. These delays can be costly, as the patent clock on new drugs starts ticking as soon as the patent is filed.”

So, when Dr. Nasrallah encourages “freshly minted” psychiatrists to refer “patients” to clinical trials, whose interests are being served?

It is also noteworthy that the only kinds of research included in this principle are drug trials and biological investigations. There’s no mention of research into psychotherapy which Dr. Nasrallah had earlier contended “… must always be provided side-by-side with medications.”

. . . . . . . . . . . . . . . .

 Dr. Nasrallah concludes his editorial with this:

“You, the readers of Current Psychiatry, include thousands of experienced psychiatrists with years of practice in the real world. I invite you to add to this list of principles by writing to me at [email protected] Join me in providing the freshly minted psychiatrists words of wisdom about the DNA of psychiatry to guide them before they embark on their careers as psychiatric physicians.”

In other words, keep them within the pseudo-medical world of bio, bio, bio psychiatry. Make sure that they don’t fall prey to the pernicious influences of anti-psychiatry. Guide them in the path of psychiatric orthodoxy. Chain them to the hoax. Get them young and they’re yours for life.

BUT

There’s one principle of psychiatry that Dr. Nasrallah has omitted, if, that is, we are to consider his own career to be exemplary of psychiatric practice:

Cultivate mutually beneficial relationships with pharmaceutical companies.

According to the site OpenPaymentsData, Dr. Nasrallah’s payments from pharmaceutical companies for the years 2013-2016 (most recent years for which data is available) were:

2016:   $332,412.77;
2015:   $304,252.38;
2014:   $218,527.61;
2013:   $114,368.32

The CMS site above also breaks down the information by individual payments. Dr. Nasrallah’s receipts for 2016 ran to 39 pages!

Here is page 1:

 

Here is page 10:

 

Here is page 20:

 

And here is page 39:

 

For a 2016 grand total of $332,412.77. Not bad for a practitioner of psychiatry’s chaotic, antiquated, hit-or-miss approach!

COMMENT

At the present time, psychiatry is under intense scrutiny and criticism. On all sides its “mental illnesses” and “brain-correcting” drugs are being exposed as dangerous, disempowering, and stigmatizing hoaxes. And psychiatry’s only response is denial, PR, cheerleading, and attempted marginalization of its critics.

In this article, Dr. Nasrallah is squarely in the cheerleading camp. The picture he paints of psychiatry is unrecognizably rosy. There is no acknowledgement of the fake illnesses, the dismal Kappa scores, the link between antidepressants and the murder-suicides, the adverse effects of high-voltage electric shocks to the brain, etc., etc.

According to Dr. Nasrallah, psychiatry is in fine shape. And, I suppose, from his perspective, perhaps it is.

48 COMMENTS

  1. The reality is that none of us can sleep before visiting the psychiatrist for fear of what this misinformed pseudo-medic will “do” next.

    Psychiatry is not ok. In the UK it’s time the authorities looked at the misinformation campaign around the SMC and the RCPsych and ask whether people should be held accountable for falsehoods.

  2. Wonderful. Shrinkology hasn’t been around for 200 years, and already it is encoded into the DNA of shrinks.

    I have to pause long and hard over the eugenic (or nugenic) aspects of Dr. Nasrallah’s defense of the bio-shrinkology orthodoxy.

    The corollary to his genetically endowed shrinks are his genetically deficient patients, and the only thing to be done is drug, drug, drug.

    That, or if you can see past the drug haze, to figure out that you have been, what shall we say, “punked” by shrinkology.

    This brilliant future knowledge has been leading these dummies around blindly for more than a century, but what of it? As in this piece by Dr. Nasrallah, the idea is still very useful when it comes to crafting shrinkology propaganda.

    The moral is…more shrinks, more patients, more drugs, less sense. People could either wise up, or, as ‘ignorance is bliss’, settle into a extended hybernative state with which to avoid facing the increasing global warming crisis.

    You say the world is getting hotter. It must be entirely due to a conspiracy of mental patients I’m sure. The answer, of course, must be to pump more and more money into shrinkology.

    That way they will learn, won’t they?

  3. Another excellent post.

    “antipsychotic medications do not have negative long-term effects on patients’ outcomes or the brain. In addition, the benefits of these medications are much greater than their potential side effects.” [Emphasis added]”

    The Dr should be made to take Olanzapine, it will soon cure the delusions.

  4. Dr. N has some pretty new lipstick. Coral didn’t go with the pig’s complexion; maybe candy pink will.

    As far as the first principle goes, shrinks and everyone else at your mental illness center are 100% opposed to recovery since it’s bad for business.

    By recovery I mean a productive, independent, satisfying life. Psychiatric “cures” guarantee none of the above!

  5. Best.
    Nice work Philip. I myself have tried to write on this topic a few times but was not able to do so. You too alright good article.

    This topic can get sidetracked. That’s fine oh b yes but dwelling can be horrific. b

    b I say to me Pat get in tune to straight and arrow.

    There awesome. The best. There’s not much more to say.

  6. “At the present time, psychiatry is under intense scrutiny and criticism. On all sides its ‘mental illnesses’ and ‘brain-correcting’ drugs are being exposed as dangerous, disempowering, and stigmatizing hoaxes. And psychiatry’s only response is denial, PR, cheerleading, and attempted marginalization of its critics.”

    No one says it quite as clearly and succinctly as Dr. Hickey. Excellent article.

  7. Psychiatry is a theology in medical disguise. And psyche roots are pagan, Greek, imaginal, not scientific, but imaginal, poetic, which means – polytheistic. This is a death camp for psychic reality ruled by church/theology, medicine and science and they have one master – pseudo rational apollonian ego and economy = DSM power.
    Yes, psychiatric language is only an empty dehumanising nominalism, for biurocratic machine to work for authoritarian sect, they all prey on the buried by theology/pseudo rationalism invisible body of human psyche, SEEN TODAY AS EVIL OR PSEUDO BRAIN DAMAGE.. You could use diagnosis only with proper understanding of human psyche, as a psychological map, not as a theological pseudo scientific condemnation in medical disguise. But without phenomenology and proper great meaning given to HUMAN psyche, we have only authoritarian BS with scientific pretensions in pseudo humanistics system RULLED BY MONEY.
    Manufacture of madness, and Re- Visioning psychology are the ONLY BOOKS WHICH DESCRIBE the reality behind word STATE, mental illness, psyche. Without this knowledge and phenomenology in place of DSM, ther will be no human reality, only authoritarian fictions for money. Psychiatry created AUTHORITARIAN reality,not human reality.. . And psyche does not exists because there’s no language describing it, THE HAVE BURIED pro psychological language and the phenomenology of the psyche. The victims of psychiatry are victims of primitive psychopatic language and psychiatry knows that the language is everything. Medicine, theology and science destroyed psyche, and that’s why church has got Vatican, and psyche a death camp.
    Psyche/ psychological man don’t need DSM judgements or cure but the pro psychological BLACK PANTHER’S PARTY AND FREEDOM FROM AUTHORITARIAN FAKE REALITY CREATED ONLY FOR BIUROCRATIC MACHINERY and church. AND NOT FOR PSYCHOLOGICAL MAN.
    Church talks a lot about antichrist and numbers and nothing about PSYCHIATRIC DEHUMANISATION. It is not strange? Maybe the antichrist system will be a punishment for church/world/science silence?

  8. Are Dr. Nasrallah’s ears burning? 20 minutes ago I read his forward to a book penned by a long term patient of his. But then again, from the statements displayed in this article, we know Nasrallah is incredibly busy.

    I have Tardive Dyskinesia. Dr. Nasrallah’s name comes up quite a bit in these circles.
    I often wonder what my life would have been like if I’d never gotten enmeshed in ‘the system.’

  9. So has society lost its ability to recognize false logic, or are people too intimidated to reveal their inner suspicions when they pick up on any of the disingenuous contradictions permeating such thoroughly mediocre propaganda? That’s what someone should be getting some research funds to investigate. In a “sane” world the dissemination of this sort of pablum would be roundly mocked and the author discredited.

    Good to hear from you Phil.

  10. I get good ideas when it comes to this specific topic during the Zumba class. I attend several times weekly after I’ve hit the gym. It is predominantly people my age l all actually and it’s just what I need as a 40 year old man.

    Psychiatric practice could go together with neuroscience. Like be improved a lot to be included with neuroscience. Reading Oliver Sax I think I would improve field a lot for people who utilize and access psychiatry.