Before describing how psychiatry’s medical model traumatizes and retraumatizes—both overtly and insidiously—and before distinguishing genuine healing from psychiatry’s perversion of this term, I will begin by tackling the following question:
What Exactly is Psychiatry’s “Medical Model”?
Psychiatry’s medical model is essentially a disease model. While there are controversies about its definition—which I will return to—in common practice, psychiatry’s medical model consists of (1) diagnosing a person with a mental illness if the person has been assessed to have enough qualifying behaviors termed by psychiatry as symptoms, and (2) treatment consisting of eradicating as quickly as possible these symptoms. Unlike illnesses and symptoms in the rest of medicine, mental illnesses and their symptoms are voted in as such by the American Psychiatric Association (APA), the guild of American psychiatrists and publisher of the DSM.
Ignoring the voting issue—as well as the absence of any objective diagnostic tests—psychiatry’s imagined medical model approximates the model of the rest of medicine. In psychiatry’s medical model, attention deficit hyperactivity disorder (ADHD) and schizophrenia are—like gonorrhea and cancer—seen as pathological conditions which are diagnosed based on symptoms, and medical treatment consists of eradicating the condition, with the idealized goal being the eradication of the cause of the pathology, and the practiced goal of eradication of its symptoms.
So, what then are controversies about the definition of psychiatry’s medical model?
Perhaps the most significant one is whether or not the medical model means an exclusive focus on biological causality and biological treatments. While psychiatry generally views mental illnesses as biological in nature—be it chemical imbalances (now a discarded theory), defective circuitry (current theory), or other theories involving brain and genetic defects—psychiatry’s medical model does not preclude the effect of psychological and social factors on biological functioning. Just as oncologists embrace the idea that genetics predisposes a person to cancer but psychological and social variables can trigger the cancer, so too does psychiatry’s medical model embrace the idea that psychosocial variables can trigger DSM mental illnesses.
The essential aspect of the medical/disease model is the designation of a phenomenon as a pathological one with treatment consisting of eradication of the pathological phenomenon or, at the very least, eradication of its symptoms.
It would surprise many people who are hostile to psychiatry’s chemical and electrical “treatments” to discover that they too may embrace a medical model if their approach accepts inattention, depressed mood, anxiety, substance abuse, and hearing voices as “illness symptoms.” Whether the treatment be antidepressants, electroconvulsive therapy (ECT), vitamins, or cognitive-behavioral therapy (CBT), these are not departures from the medical model as long as the goal is the eradication of the “symptoms” of “illness”/“disease”/“disorder”/“pathology” (or some other such term connoting defect). This is not to say that all “treatments” have equal potential for traumatization, as certainly ECT—which damages the brain and disconnects a person from memories—is going to have a more traumatizing effect than CBT (I will return later to the essence of trauma).
In one of the oddest wrinkles of psychiatry’s medical model, psychiatry officialdom tells us that their medical model does not necessarily mean that all DSM symptoms should count as illness symptoms. Specifically, psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, in his article “Hearing Voices and Psychiatry’s (Real) Medical Model” writes: “Psychiatry also recognizes the cultural and religious context in which some people ‘hear voices’—and the non-pathological nature of such experiences.” Pies continues, “Thus, DSM-5 notes, ‘In some cultures, visual or auditory hallucinations with a religious content (eg, hearing God’s voice) are a normal part of religious experience.’”
Thus, similar to the medieval Catholic Church with respect to selling indulgences to expunge sins from one’s “heaven-hell record,” psychiatrists can declare an individual with DSM symptoms of pathology as not evidencing pathology. In practice, such “get-out-of-mental illness cards” are handed out with regard to (1) the political consequences of declaring individuals with such symptoms to be mentally ill (for example, preempting an attack on psychiatry by that group of people who hear God’s voice); and (2) if psychiatrists themselves have experienced DSM symptoms (for example, declaring their own inattention to a boring lecture as not a symptom of ADHD, though diagnosing their patients’ inattention to them as ADHD).
Curiously, despite Pies’ declaration that in certain instances hearing voices such as God’s voice are not evidence of mental illness, he next states: “That certain human experiences or perceptions (eg, ‘voices’) have a discernible ‘meaning,’ symbolism, or psychological significance for the patient does not mean they have no neuropathological etiology.” So, according to Pies, hearing God’s voice can be meaningful and “non-pathological” but still have a “neuropathological etiology.” The logic here, if there is any, escapes me.
On an intellectual level, psychiatry’s medical model is hypocritical and confusing, so much so that psychiatrists’ explanations can appear to non-psychiatrists as “grossly disorganized speech” (a DSM symptom of schizophrenia).
However, on a political level, psychiatry’s medical/disease model can be summed up rather easily: Psychiatry believes it knows the symptoms of mental illness, and when psychiatrists declare that individuals have a mental illness, psychiatry’s ideal goal is to eradicate the cause of the illness, and its practiced goal is to eradicate the symptoms of the illness.
How Does Psychiatry’s Medical Model Insidiously Retraumatize?
While psychiatric “treatments” such as ECT, surgical lobotomies, and chemical lobotomies are overtly traumatizing, the focus in this article is on the traumatizing effects of psychiatric “diagnoses.” And while it is obviously traumatizing to pathologize—as psychiatry has done—normal sexualities (such as homosexuality and bisexuality), normal temperaments (such as introversion and anti-authoritarianism), or other aspects of people’s essential nature, there is a more insidious way that all psychiatric “diagnoses” routinely traumatize.
When healthcare professionals—and this includes not only psychiatrists but primary care physicians, psychologists, and other mental health professionals—communicate to their patients the idea that their patients’ inattention, depressed mood, anxiety, substance abuse, hearing voices are “symptoms” of “mental illness,” and when patients accept a mental illness/disorder/pathology/defect label, they will be traumatized or retraumatized.
I say retraumatized because these so-called “symptoms” are not evidence of an illness/disease/disorder/pathology/defect but often are simply coping mechanisms for traumatic events; in other words, fight/flight/freeze mechanisms in reaction to violations—coping mechanisms that have become habituated and become counterproductive and dissatisfying with respect to current navigation and enjoyment of life.
The definition of trauma is controversial, but I believe that the essence of trauma is in the disconnection reaction to an event. The event may be an obviously horrific violation such as rape or lobotomy, but a physical violation is not necessary for traumatization. While a child can develop the coping mechanism of inattention in response to an abusive family, I have talked to many young people whose inattention was a coping mechanism in response to their coercive schooling which was oppressive for them. We are traumatized to the extent that the event results in the reaction of disconnection, specifically a disconnection from essential truths—including the truth of who or what violated our being, from the truth of our being, and from other truths including sociopolitical ones.
Owing to many variables—including the absence or presence of support and protection—we will be more or less vulnerable to disconnection.
If I were ten years old and a psychiatrist told me that my often arguing with adults, often refusing to comply with adults’ requests or rules, often irritating adults, and often being irritated by adults were symptoms of the mental illness of oppositional defiant disorder (ODD), and if I had no support or capacity to protect myself from this “diagnosis”—and then internalized this pathology identity—I would be traumatized. If I accepted the idea that I was mentally ill, I would be disconnected from the truth of exactly what was threatening me, the truth of my being, and the truth of why I was engaging in those behaviors that psychiatry calls “symptoms” of a “disorder.” If I accepted the psychiatrist as a legitimate scientific authority, I would also be disconnected from the truth of the essence of psychiatry. In contrast, if I was told today as an adult by a psychiatrist that because I refused to comply with illegitimate authorities that I had ODD or “authority issues,” I would be too busy laughing to be traumatized by such bullshit.
Psychiatry traumatized millions of homosexual individuals who accepted psychiatry’s “diagnosis” that they were mentally ill because of their homosexuality (with many of these individuals also traumatized via “treatments” that included ECT, castration, lobotomy and, more commonly, “aversion therapy,” in which electric shock to the genitals and/or nausea-inducing drugs were administered simultaneously with the presentation of homoerotic stimuli). However, psychiatry did not traumatize writer Gore Vidal (1925-2012) because he was confident at an early age that his homosexuality was a perfectly normal human variation and that his society had a bigoted and intolerant view of homosexuality—and he was confident that psychiatry was perfectly full of shit, which stripped psychiatry from power to traumatize him.
Psychiatry’s Perversion of Healing
Healing: Our Path from Mental Illness to Mental Health (2022) is the title of a recently published book by psychiatrist Thomas Insel, former director of the National Institute of Mental Health (NIMH). The original title of this book, according to the New York Times, was Recovery: Healing the Crisis of Care in American Mental Health, and so it is no surprise that Insel uses the word healing synonymously with recovery—specifically, recovery from mental illness to mental health. And the following example from Insel’s book reveals how, for psychiatry, major “symptoms” of mental illness are behaviors which create tension for authorities, and that mental health is a state that does not create tension for authorities.
Insel tells us, “When my son showed every sign of ADHD,” he and his wife initially tried non-medication methods that were unsuccessful, but then a “child psychiatrist friend recommended a pilot trial of methylphenidate (sold under the trade name Ritalin).” After Insel’s son was given Ritalin, Insel reports, “Within a few hours we watched our whirling dervish slow down, put away his toys, and begin to listen for the first time. We were stunned. But our son was unimpressed. We asked him about the medication a week later. His response remains one of the most convincing statements I have ever heard about psychopharmacology.” Insel’s son’s response? “Doesn’t do much for me, Dad, but it makes everybody else a lot nicer.” For Insel, that may be healing but not by my definition of it.
There are of course psychiatric patients who state that acquiring a psychiatric diagnosis and receiving biochemical-electrical treatments helped them feel better. For some people, it can “feel better” to accept a socially acceptable label of defectiveness (be that label one of sinner or mentally ill) and then comply with the procedures of authorities (be they clergy or doctors). There is the “feeling better” relief that comes from being believing that one has become more socially acceptable; and for some people, their biochemical-electrical treatments can numb their pain (or function as a placebo that fulfills their expectations of pain relief). All of this, for some people, can “feel better,” at least initially.
The experience that some people report of “feeling better” following their acceptance of a psychiatric diagnosis and compliance with treatment is not synonymous with healing. Healing is about reconnecting and becoming more whole. In our culture, many people have never experienced the pleasure and power of truly healing, and so they cannot make this distinction. In a sane society, mental health professionals would know the difference, but we do not live in a sane society.
Among mental health professionals, it is especially common for psychiatrists—because of their medical schooling socialization—not to make this distinction between “feeling better” and true healing. Those few psychiatrists who do make this distinction are likely subject to ostracism by their colleagues—and vulnerable to retraumatization. I say retraumatization because becoming a psychiatrist is—in common with substance abuse, inattention, and voice hearing—likely a coping mechanism to control pain, often the pain of a dysfunctional family of origin.
So, how does deconstructing psychiatry’s medical model and understanding how it traumatizes and retraumatizes help us to heal?
Being traumatized means being disconnected, including being disconnected from one’s own being, from others, and from other aspects of life; and the beginning of healing from trauma requires stripping power away from disconnecting violators. The stripping of power from a disconnecting violator is a necessary first step to reconnecting, but it is not sufficient, as it only opens the door to healing. The good news is that once the door is opened, there are as many reconnecting paths to wholeness as there are different human temperaments and cognitive styles.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.