Psychiatry in Need of “Fundamental Rethinking”

Prominent researchers in psychiatry urge the field to move away from a rigid biological focus toward social and psychological perspectives to meet the needs of today’s world.

Hannah Emerson
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In a recent commentary in the New England Journal of Medicine (NEJM), leading researchers in psychiatry write that the discipline is experiencing an identity crisis and lay out the consequences of this crisis for trainees, psychiatrists, and patients alike. The prominent authors, Caleb Gardner of the Department of Psychiatry at Harvard Medical School and Arthur Kleinman of the Department of Global Health and Social Medicine and Department of Anthropology at Harvard University, write: 

“Psychiatry finds itself plagued by overprescription of psychiatric medication for a large segment of the population; abandonment and incarceration of people with chronic, severe mental illness; and an increasingly unwieldy diagnostic system of overlapping symptom checklists.”

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Gardner, a psychiatrist at Cambridge Health Alliance, is co-author alongside physician and anthropologist Kleinman, who has been a leading figure over the past four decades in psychiatry, culture, and healing. Kleinman is the founder of the journal Culture, Medicine and Psychiatry, and is a leading figure in medical anthropology, cultural psychiatry, global health, social medicine, and medical humanities. Kleinman is also an author on the 2018 Lancet Commission on global mental health and sustainable development that outlines a blueprint for action to promote global well-being through the “scaling up” of mental health treatment internationally.

The article begins with an approximately 100 year-old quote from renowned psychiatrist and philosopher Karl Jaspers observing that the biologic and psychological inquiry of the mind is akin to, “the exploration of an unknown continent from opposite directions, where the explorers never meet because of impenetrable country that intervenes.” Gardner and Kleinman note that it has been psychiatry’s endeavor since then to push exploration into the interior while attempting to alleviate suffering of people in real time.

Yet, the limitations of biological understandings, combined with the current emphasis on finding the “right” diagnosis with the “right” medication, hinder the potential of psychiatry to alleviate suffering. The authors explain that while there is “no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders,” social psychology and anthropology have been able to systematically examine and conceptualize the ways in which the social world impacts well-being and illness.

Gardner and Kleinman discuss the intricacies of incorporating a perspective that acknowledges the effects of interpersonal relations, like culture and family dynamics, along with the progress and promises of new discoveries in genetics and neuroscience. Despite progress in neuroscience, these discoveries are still far from offering real support to real people today. They admit, “Given the complexity of the human mind, this gap is not surprising.” 

The authors describe how it seems the field has “largely abandoned its social, interpersonal, and psychodynamic foundations, with little to show for these sacrifices.” Current crises such as addiction, global aging, effects of immigration, and attention to children and adolescents call for expertise in more than just biologic research, yet psychosocial, cultural, public health, and community research have been marginalized, along with a decrease of attention towards the clinician-patient relationship. 

“We believe that a fundamental rethinking of psychiatric knowledge creation and training is in order,” Gardner and Kleinman write, adding:

“Biologic psychiatry has thus far failed to produce a comprehensive theoretical model of any major psychiatric disorder, any tests that can be used in a clinic to diagnose clearly defined major psychiatric disorders, or any guiding principle for somatic treatments to replace the empirical use of medications. Biologic knowledge is foundational to good psychiatry, but we believe that misapprehension of its limitations is stunting the field from within and subjecting it to manipulation from without by corporate and administrative interests that, intentionally or not, strive to benefit from falsely simplified and deterministic formulation of mental illness and its treatment.”

The authors call on academics to lead the way in rebuilding psychiatry by way of desegregating the complementary relationship of biology and dynamic psychology. They suggest psychiatric training programs need to promote multiple perspectives of psychiatric research rather than endorsing a linear approach grounded in biologic perspective.

Gardner and Kleinman conclude by referring back to the initial metaphor of biologic and psychological exploration of that unknown, wild continent, the mind, allowing us to think about it as an even vaster and more mysterious country than we previously imagined. 

They determine that exploration which leans on the interconnections of “mind, body, and society” and interdependence of “mental, medical, and social health” is needed in order to expand the field’s ability to meet the needs of individuals requiring relational care to effectively and humanely relieve suffering. 

 

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Gardner, C. & Kleinman, A. (2019). Medicine and the mind – the consequence of psychiatry’s identity crisis. New England Journal of Medicine 381, 1697-1699. doi: 10.1056/NEJMp1910603 (Link)

21 COMMENTS

  1. “They determine that exploration which leans on the interconnections of “mind, body, and society” and interdependence of “mental, medical, and social health” is needed in order to expand the field’s ability to meet the needs of individuals requiring relational care to effectively and humanely relieve suffering.”

    Thank you for this article, Hannah. Lovely job, especially at the end. ‘Relational care’, also sometimes referred to as ‘spiritual care’ was what Jesus practiced and preached, and is also a familiar concept in Judaism. I think a major challenge of an increasingly secular society is learning how to provide this kind of care for each other. (Can we learn to care for each other absent religious dogma and judgment?)

    I think it’s also highly telling that the only presidential candidate preaching this message of love and caring for each other – Marianne Williamson – has been roundly criticized in the mainstream media as “nutty”, “kooky” and similar derogatory descriptors. I find myself increasingly on the side of Dr Breggin’s Team Love. To love and be loved is what it’s all about. Everything else is window dressing. But how do we bring this into mainstream consciousness? That’s where I despair.

  2. MiA is giving a false view of what psychiatry really is. It’s not a medical discipline. It has far more in common with the police, indeed you will find police cells in psychiatric hospitals. Psychiatrists who work in these places don’t give a fig about treating an illness, they just use drugs as a chemical cosh. They are chemical thugs enabled by the state. And it doesn’t matter what illness you’re suppose to have. If say, you have severe anxiety, for sure you’re going to get 400mg to 700mg of ‘anti-psychotic’ Quetiapine. For those of you who have been on the end of this, you will know the meaning of a chemical thug. They don’t care the pain and horror you experience…. you’re getting it.

    • Psychiatry has infiltrated into all other systems. THAT is an even bigger issue. It is about eliminating psychiatry yet does that eliminate it’s far reaching tentacles? Popular opinion is a difficult thing to eliminate. I think it exists purely by popular and majority opinion.

      • It fascinates me listening to the latest sports star who is in need of mental health services. We hear vague descriptions of their diagnosis and when the ’emerge’ (note they emerge, not drag themselves out with little if any of their life in tatters) they are seen as poster children for seeking assistance if you need it.
        Oh how far all that is from the truth. I mean it’s like they fly to Paris for lunch at Maxims and return feeling satisfied, when what the average Joe gets is scraps that have been dragged out of the dumpster and left to rot for a week and will be lucky if it doesn’t result in a trip to the Emergency Dept. Oh, and if you don’t like the look of what they dish up on the plate, they’re going to have 12 thugs pin you down and shove that muck down your throat.
        Still, sports people used to get folk smoking too. So the idea of them luring young folk into something that will damage their health for life is not unheard of.

  3. There is a “comprehensive biologic understanding of … the causes … of psychiatric disorders.” The ADHD drugs and antidepressants create the “bipolar” symptoms.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    The antidepressants and antipsychotics/neuroleptics create the positive symptoms of “schizophrenia,” like psychosis and hallucinations, via anticholinergic toxidrome, which is NOT any of the DSM disorders.

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

    And the antipsychotics/neuroleptics create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome. Which is also not “schizophrenia.”

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

    The primary actual societal function of psychiatry and psychology, historically and today, is to misdiagnose and silence child abuse and rape survivors, despite this being illegal. “today the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

    https://www.madinamerica.com/2016/04/heal-for-life/

    And a little about the psychologist’s historic and continuing child abuse and rape covering up crimes.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    And all this child abuse and rape covering up is by DSM design. Today NO “mental health” worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, unless they first misdiagnose them with one of the “invalid” but billable DSM disorders. Which is not helpful for abuse survivors.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    And it seems the reason our society has placed power in the hands of the scientific fraud based psychiatrists, other “mental health” and social workers, is because the powers that shouldn’t be – who love Spirit cooking and pedophilia artwork – are working to turn America into a communist country, at least according to the communist manifesto.

    “38. Transfer some of the powers of arrest from the police to social agencies. Treat all behavioral problems as psychiatric disorders which no one but psychiatrists can understand [or treat].”

    http://ibankcoin.com/zeropointnow/2016/11/26/sick-lets-revisit-the-podesta-penchant-for-pedophilic-cannibalistic-and-satanic-art/

    But the psychiatrists and other “mental health” workers are, obviously, arresting the victims, rather than the criminals, according to the medical evidence. I was attacked twice by Lutheran psychologists, because I am the mother of a child abuse survivor, and the ELCA Lutheran religion, in “conspiracy” with the “mental health” workers, has turned itself into a child abuse covering up and profiteering religion.

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    https://virtueonline.org/lutherans-elca-texas-catastrophe-coming-lesson-episcopalians

    And I was attacked once by a school social worker, because my child had healed, and gone from remedial reading after the abuse, to getting 100% on his state standardized tests in eighth grade. Shouldn’t the school social workers be congratulating such a mother, rather than attempting to get their grubby little hands on the best and brightest American children? WTF???

    America needs to return to being a country where the rule of law applies to all people, including the pedophiles. Because this communist theology that the scientific fraud based psychiatrists – who’ve been systemically “arresting” the victims rather than the criminals – should be in control has resulted in the pedophiles and child sex traffickers running amok in America today, even according to world leaders.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines

    https://www.nytimes.com/2018/04/11/us/backpage-sex-trafficking.html

    https://worldtruth.tv/putin-the-west-is-controlled-by-satanic-pedophiles/

    Rather than reforming psychiatry, and continuing to have psychiatrists, who are DSM deluded people, in charge. They’ve yet to flush their DSM “bible,” despite it being confessed to be “invalid” and “bullshit,” by leaders in their industry.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    https://www.wired.com/2010/12/ff_dsmv/

    America should return to the rule of law, and start arresting the pedophiles and child sex traffickers instead. And the scientific fraud based psychiatrists, psychologists, and other “mental health” and social workers, should have their power stripped from them, since they are child abuse covering up criminals, and possibly also child sex traffickers. And because many people would like to see their modern day psychiatric holocaust end.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    • I am starting to see that flushing the DSM bible won’t do much good at all. Alternative ‘helpers’, be they psychologists, counselors, therapists etc, still judge and often do so by the influence old psychiatry had on them/us. A good example even on MIA, is the subject of BPD. The very notion that we can keep clinging to “certain behaviours” idea of that label, tells us that we chose to adopt a label from the DSM and mainstream psychiatry. Up there in our heads we have concluded that ‘those people over there’ are ‘akin’ to such and such ‘disorder’. So it makes no difference if we shut the DSM book, the judging started with the beginning of mankind. Somewhere along the line, be it priest or counselor/therapist, someone will cling to diagnosis theory, even if just quietly within their minds. The seeds were planted to try and heal/help people…..we seem not to be able to live a life without judging folks, always superimposing our subconscious story over another person’s story. I have spoken to many, and walk away so unsatisfied. To connect with someone is difficult. They speak of doctor/patient relationships, therapist/’patient’ relationships. The word here that stinks is ‘patient’. The word human/human seems more appropriate. I have yet to meet someone in a ‘public service’ area that does not project that they know better or more…..At the moment, due to my physical illness I am going through horrible anxiety. The anxiety is a natural component, not a fear of the disease. And the surprise is, few people would understand this.

  4. Perhaps if they had not touted theory as fact, not produced pills for theories, not named every human difficulty, path, or existence as a pathology. Oh well, lets see what they have on hand to replace sham psychiatry. I doubt they can change, since their belief systems are entrenched. There will always be persons who develop to observe others, beyond a quick Passover, thinking of others as less normal, it is those kinds of persons that will look for occupations where that thought process can continue. I wish they, parents and teachers would stop medicating kids. THAT and much else within psychiatry should become a human rights concern. Really they should consider that in the future there might be lawsuits regarding feeding kids brain chemicals. I do hope to see that in the future.

    • No doubt there are concerns Sam.

      They had to make sure that the age of consent for ECTs was made explicit in our new MHA. Doctors were getting worried that someone might bring action over the use of it on young teenagers. Not that there is a lawyer in my State who would dare think of bringing action against the gods of psychiatry, there families would be targeted immediately (as mine was). Still, the public seems happy with this medical mafia running our State so who am I to complain.

      • The right to consent.

        Okay Boans we have found out that there are some people who want to do you harm (if you’d stop complaining about the torture and kidnapping), but we don’t know exactly how they are going to do it. What we do know is that they have asked your wife to get you to attend the ED at a particular hospital. You wife has given me a copy of one of your favorite books and i’m going to call you and make friends and ask that you go along with us to find out what they intend doing to you.
        My response, fuk off professor.
        So it gets done without my consent, and yeah okay so they are hotshotting folk in the ED. I still think I had a right to know what they were using me for. A stakeout, and I still laugh to this day at the look on that doctors face when they snatched him right in the middle of trying to kill someone. He really did think he was god.

        Still, keep talking like that Boans and they will have reason to drug you into a stupour. Because that’s what they have always done when the truth doesn’t suit them If it were a problem the guy doing the hot shots wouldn’t be getting promoted to head of the doctors union right? Might be of more use in that position than rotting in a jail for killing people.
        And let me say the police obviously know its going on because they tell me “it might be best they don’t know about it” when you turn up with the proof. They make referral behind your back to the people doing the nasty.
        Oh it just got a little out of hand. Really? I get spiked with a date rape drug to plant a knife on me and have police rough me up to get me to talk to a Mental Health Professional? One who knew he was committing serious criminal offences by lying to police and claiming I was his “patient” and they can’t see how this might turn out bad?
        Okay, so a bit of stupefying to commit and indictable offence namely kidnapping (40 years) we might want to call in a favour from the Doc. Means, motive and opportunity, but with the hospital removing the motive via fraudulent documents the killing can be done with impunity. Not that i’d expect our police to get this, they’re too busy beating up on mental patients and aboriginals to be concerned about the top end of town.

  5. So, the mental health preachers have made it their task to alleviate human suffering. I think the vastness of this project is one of the things that makes psychiatry a religion rather than a scientific discipline. Disease is one thing, and definitely physical, suffering is another. I’m sure everybody by now knows the adage about ‘the road to hell’.

    “They suggest psychiatric training programs need to promote multiple perspectives of psychiatric research rather than endorsing a linear approach grounded in biologic perspective.”

    Not only do we have behaviorists, and psycho-dynamic counseling, but we’ve also got Catholics, Hindus, Muslims, and Jews.

    I’m personally not looking for a savior. Please, don’t pretend to be one.

  6. To Hannah:

    Nice to know some at Harvard University are trying to wake the world about psychiatry!

    Yet, who is to blame? Pharma would be a good starting guess. Or doctors who are allowed the drugs, knowing them as a futile attempt toward treatment? Then again, maybe it’s just the general public wanting for a “Magic Bullet Cure.“

    The disastrous scale of this message to
    psychiatry is so massive. What really needs to happen won’t.

    An entire world cannot begin to understand how much they have been harmed!

    Just sad.

    Psychiatry is not all bad, but it will not be them leading the way in the future. My experience as a client of many of them has been that they don’t seem to have a clue about what the drugs ”really” do, and it’s getting a bit late to fess up to these falsehoods and others.

    What the world needs is NOT psychiatrists but scientists. It needs people who question WHY (all the time) about the biology of life.

    P.S.

    Maybe a lot of motivation THESE DAYS is money. It’s a crisis in the worst way.

      • I wonder about that sam. For example when my wife spiked my drink with benzos to make it easy to plant a knife on me and obtain a police referral, i’m sure it all seemed like a good plan at the time. However, after 6 weeks of being run around and the FOI officer at the hospital telling my wife what she needed to ensure I couldn’t get the proof (ie a back dated referral making me a “patient”) they caved and handed over the documents (redacted).
        So I asked my wife “Why didn’t you just tell me the truth about the spiking?”. Her response was that the FOI officer had threatened her because if I knew about that then their criminal conduct would also be exposed. And they didn’t want that, because conspiring to pervert the course of justice carries a mandatory prison term. And i’m sure they were not aware that police don’t have a copy of the criminal code so are only arresting people based on the color of their skin and whatever they think might be crimes (eg loitering near a crosswalk with the intention of using it).
        What if the person doing the watching believed something false? What if the person who was doing the beating said it was because the person deserved it. What if the person being beaten had been slandered as “patient”and then beaten under lawful sanction? Which is what surprised me about the police not only standing by while the community nurse did a kidnapping and torture, but why they actually assisted him. Then with his fraud exposed it becomes obvious to anyone who cares to look. Unfortunate that the police are allowed to refuse to perform their duty because they must be terribly embarrassed about being used to kidnap and torture citizens.
        It really came as a shock to me to find out that what was being done in the locked ward did not constitute torture. I mean it sure as Hell looked like it. But then I found out about the loophole being exploited in the Convention (Article 1.1) that it was “inherent in or incidental to lawful sanction” and all one needs to torture your citizens is a corrupt psychiatrist. And well,,, we know how easy that would be with a fist full of cash. So good people stand and watch with the personal justification that the person is being beaten with lawful sanction and thus they do nothing. Bit like the guards at Auschwitz had no qualms about their duty being lawful and would not even question the ethics of it all. Just doing my job. Altruistic evil i’ve heard it called.
        Put them to the integrity test though and ensure that they know what they are doing is evil, and don’t allow them to later claim they didn’t know. At least Ned Kelly accepted his fate when they hung him (Such is Life), unlike the National Socialists who denied any wrongdoing until they got to shake hands with Albert Pierrepoint.

  7. “Hello, Is there anybody out there?” Pink Floyd.

    I don’t know but are there any other mental health professionals using the methods of this Community Nurse that I came across? Maybe it’s seen as a ‘trade secret’?

    Basically have the person you want to torture and kidnap spiked with benzos and plant a knife on them and then run with two narratives. You call the police and request assistance with a “patient” and they oblige by coming and detaining the target for you (thinking that you have the lawful authority to have the target detained), and causing an acute stress reaction (combined with the spiking with benzos which you fail to inform police, or the doctors at the hospital about). You then interrogate the target and verbal them up on Forms and refer for an examination by a psychiatrist and run with the narrative at the hospital that your referral was from the police. The police are now doing your kidnapping for you and if their is any complaint to police they won’t even touch it because it’s a complaint from a “mental patient” and will simply send them back to the kidnappers to be dealt with. There is of course that little problem with the thing called the law, but fortunately our police tell me they don’t have a copy of the Criminal Code in their stations anymore. Because lying to police, procuring, uttering, kidnapping, intoxication by deception, stupefying with intent are all listed in there as crimes.

    Don’t think it can be done? I can prove it despite the best efforts of my government to cover this up. No harm done, lost my home, my marriage, my grand children my career, my sanity and the Community Nurse was off to do another one that afternoon. What was he supposed to do? And the whole community supports him. Perhaps because they don’t understand that what he is doing is criminal? No, they know alright. I checked.
    More importantly, there is no avenue for complaint regarding the use of known torture methods in my country, despite this being a requirement under the Convention. So the ratification of that document may make the community feel a little safer, but the folk who signed it never intended to honor that document, in any way. Refoulment is their solution to any complaints, and they are using the Mental Health Act to refoul any legitimate complaints. And they are pointing fingers at other countries about human rights abuses? Its not that we are not doing them, we have simply passed laws that make it easy to cover them up as being ‘medicine’.
    I’m guessing that the reason the Chief Psychiatrist needed to rewrite the law and make arbitrary detentions lawful was because he couldn’t admit that one of his chosen people would commit such serious offences. And being the god that he is with the power to have citizens unintentionally negatively outcomed to resolve any little issues of torture and kidnapping why would he worry? I mean I was under the impression that parliament wrote the laws and he simply had a duty to enact what they passed, not he rewites what they pass to suit his colleagues and nobody bothers to look at what is being done to citizens and called ‘medicine’. Go figure. Sure has changed fast since they got the ability to travel through time and space.

      • It is time to make that movie. “Empty chair”…..About a global revolt, that leaves a system without patients and what happens to the minds that existed by feeding like piranhas on their ‘patients’. We have yet to explore the minds of those who explore the minds of others. It has only resulted in doctors leaving the system. I do think a movie is a good way to undermine the profession. People love movies. I think there should be a part within the movie where shrinks stand around a water cooler, looking a bit sullen, discussing their non existent field, when all of a sudden the water cooler starts moving, but all the shrinks won’t admit it to each other.